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FOR OFFICE USE: ' APP$ICATION FOR SANITATION PERMIT --------------------------- - ✓ Permit No (Complete in Triplicate) . _ ___.__ --------- ----------------------------- --- -- ---------- !`kk ____________________________ This Permit Expires 1 Year From Date Issued Date issued ------------ Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATI ------+_.`7_417!-_9----- CENSUS TRACT f ! e - Owner's Name --------- --- - - ---- �----- -- - -- ,- ------------------------- - -------- -- -Phone --- --- --- - - 0-7-V-3- Address -------------------- -- -- - ---- --n--- ------ City -- -- -------------------------------_------ Contractor's Name ----------- ----- --�---S_071f,4J----------------License ------ Phone V66_';�t0.7 s Instal.lation will-serve: . ._,----- Residence I'Apartment-Hou e[].Commercial-:❑Trailer Court_;,-]-, ...•.,..,. ._-.,...- Motel ❑Other -------- ----------------------------------- A6/ K !63 <Number of living units:._____._ Number of bedrooms -____Garbage Grinder )1-0._ Lot Size __7D_X__1_f_"]____________-________ Water.Supply: Public,System and name ----------------------------------- --------- -- 1�l ----------------------------Private ❑ Characterrcif'soil to a depth of 3 feet: Sand'❑ Slit 0 Clay ❑ eat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe Fill Material ------------ If yes, type ________________________ E t �.. .w °(PI1'ot plan, showing size'of•-1 t, location of system in relation to wells, buildings, etc. must be placed on reverse side.) `f � .� r e- e-•s•-w- t t •J� NEW INSTALLATION:_....,-(NNo septic-tank or seepage pit permitted if public sewer is available within 200 feet,) LL!! � PACKAGE TREATMENT [ ] SEPTIC TANKX Size_______X_7_. _- Liquid Depth --- 7_ ___..........-_ ` Capacity/-2{0_f/�/ Type �T Material_ 7�t/L.- No. Compartments _____-�""_ ____--./11�4 Distance to nearest: Well !'! �- -� -- •Foundation'----1-�---��--- Prop. Line -----"�---�--� I LEACHING L1N.1 [ No. of Line ------------------------ Length of each line-------J7 ---- -.---- Total Length /�--- -------- -- ( 'D' Box ----- - Type Filter Material _____Depth Filter Material --------1_ ___._____________--- __._ Distance to nearest—Well...___________________.._. Foundation _____�_�_-.�._�Property. Line r -- SEEPAGE PIT ( Depth -__ __.____ Diameter ---�_ ______ Number ___:____ .__/_� _ ock'LFilled Yes rl�lo i❑., i 1 Water Table Depth ------------------------------------ j _ Rock Size N-1/7 I -- Distance to nearest: Well ________________________________1----Foundation ___� __. �'�___ Prop. Line -------f- y- REPAIR%ADbi1rION(Prev.; Sanitation Permit# ------------------------------------------[ Date ----------------------------_----_) Septic Tank (Specify Requirements) --------------------------------------------------------------------------------------------_..-_,..--------------------------- 3 Disposal Field (Specify Requirements) --------------------------------------------------------------------------- -----------------------------------✓------------------- ----------- --- ------ --- (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin } County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: "I certify that in the performance�of the work for which this permit_is-issued-,-I-shall not employ any person in such manner as to become subject to Work man's,Compensati.on laws of California." . I Signed ----------------------------- ner --- -- ------ - ° 1'.i itle ---- ----------------------------------------------------- By ` (If other n owner) FOR DE A T_ENT USE 7;ONLY APPLICATION ACCEPTED BY = ----- /__ - -------- ��'� - ---------- ----------------- DATE -- -------- -- ---- ---------------•- BUILDING PERMIT ISSUED --- DATE ------------------------------------------- �- ADDITIONAL COMMENTS = "'� `` ----------- --- ------------------------ - . , --- -- ---- - ------- - - - ------- ------------------------------------ - - ---------- -------------------- ------ -- Final Inspection b- ---------------------Date ...7._.----------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M. j f