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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. .7-1.-..LLY.5 _.. (Completein Triplicate) .......--------- - --- --- I Date Issued .1.2.'5.:.7. __.-_-_--_-__-- -_V. This-..--- This Permit ExpiresIYourFromDateIssued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This applicatip_n is made i compliance with County Ordinance No. 549 and existing Rules and Regulations: 547 JOB ADDRESS/LOCATION _� .Ga't4-__GfC.-_.-. Zvi^..... .........----... -- CENSUS TRACT yc s -- Owner's Name - '*-------_---- ��Gr�iot�ie4 'A - ................. ...... - - Phone . - .._............. Address --------'2 P --� r� City ..,# -------------- Contractor's Name _42—rr t-------.._._..----------------------------------------------- License # ----- -----.....---- Phone ....__............ ......-- Installotbn will serve: Residence ®Apartment House❑ Commercial DTrailer Court ❑ Motel ❑Other----- ----------------------------- Number of living units:--- Number of bedrooms --- .---_Garbage Grinder ....__ .... Lot Size -'------------------------------ Water Supply: Public System and name ................................-----------------------•-.......- -------------------Private Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loom❑ Hardpan, Adobejjj Fill Material -----------. If yes,type ..__..._.......... ........ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: [No septic tank or seepage pit permitted ifublic sewer is available within 200 feet,) �. PACKAGE TREATMENT [ ] SEPTIC TANK] Size_.`f�J- `..Q------------ -------- Liquid Depth ..y..._.__......__ w Capacity . -- -_. Typr? ..j'.M . Material..&::c:.. No. Compartments ............... O Distance to nearest: Well '....S. ........................Foundation -./"........ .. __........_. Prop. Line .4. ......_....-... LEACHING LINE Al No. of Lines --------------- Length of each line----#--a 0------------ Total Length ............... 'D' Box --- Type Filter Material _._....Depth Filter Material ---/-?----------- I. Distance to nearest: Well _,571'------------- Foundation 1_Q................. Property Line :1--------------_...... SEEPAGE PIT Y' Depth ..1-4 ---------- Diameter .1_3 ..... Number ----y_------------- Rock Filled Yes No i❑ Water Table Depth -----7--a .............Rock Size 1A.e.Y.... ------...---- Distance to nearest: Well -/_07P------------------------.....Foundation ---------__ Prop. Line ..............- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ---........._..-------...----_-- Septic Tank (Specify Requirements) 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 becerrsyRublect to W ik y 's Co �y"sation laws of California." Signed ...,CrF!F41< "S.. / �1,M.46 070 _ -_ _._ Owner By --------------------- ...... _ Title - (if other than owner) n FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.._, ..G .---- - --------- .. .. ...................... .... .w -- BUILDING PERMIT ISSUED .`..,�-- - - _..-. DATE -.._... --- ADDITIONAL COMMENTS ----- . . A -------./-/r-7i------- ------------ ------------------ '---............—...... ----------------- -------------------- -------------- _- --------------- ------------------------- ................------------------------......------------------------------- ........ . ......------------------------------ .............. - ----------------------------------------------- ---- . -- -- .........__---- ....... - ------ --------------------------------------------------- --- ---------- -- -- FinalInspection by: .- - - ------ ---------------------- --------------•----.._.....----- --------- --- ---....Date ... ...-� - ------ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M