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FOR OFFICE USE: AP' ;ATION FOR SANITATION PERMIT ~ (Completain Triplicate) oe Permit No. .7 _.. 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/LOCATION / ��r'C� - .. 4e:P /7W 4�:- w1�'�T CENSUS TRACT ...... ................. Owner's Name �! .. ..-._......._ _ ,_ ..... .................... ......Phone 2�........- Address �(c'. 11114-7w e1P._ 1P- 10...... ...... ..... City . 4F2?/IiC0F._ .._—................./............... Contractor's Name Z, L c=K _.License #�'7`-�-"%�i .. Phone Installation will serve: Residence (g Apartment House❑ Commercial ❑Trailer Court [] Motel ❑ Other __ G Number of livingw units: � Number of bedrooms ........Garbage Grinder Lot Sizee, .,) ...... ............... Water Supply: Public System and name . . _-. ............. - %_.. ---_...........Private`g Character of soil to a depth of 3 feet: Sand E] Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe X Fill Material _ If yes, typel (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 if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK ( J Size... v '�5~ Liquid Depth .._e57 ............. Capacity Type Material _ No. Compartments _ ................... Distance to nearest: Well G _ ...... .......Foundation io .. Prop. Line .�r<1�!./.....-. LEACHING LINE [ ] No. of Lines -�-C Length of each line 1W Total Length oG'_�............ l 'D' Box 7 Type Filter Material X,21.-Depth Filter Material . . Distance to nearest: Well - .. .....__..... Foundation _._ Property Line . . SEEPAGE PIT [ J Depth Diameter ..... .......... Number Rock Filled Yes [ffi. No C3 Water Table Depth ...... .__-.-... .............Rock Size ... ..._..................... Distance to nearest: Well _ ..... ...... Prop. Line _..-................ REPAIR/ADDITION(Prev. Sanitation Permit# . ._ _ Date Septic Tank JSpecify Requirements) _._. - - .... _._. _. ... .. . ..... . ... _.. _.. ._......_.. Disposal Field (Specify Requirements) .. . 1 (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 su�bjsect to orkm 's Compensation laws of California." Signed !mac . _ �n� /t/. _ -..... Owner BY __. . - Title � .. (if other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY DATE .- _. .. ......__. BUILDING PERMIT ISSUED .. . . .DATE .. .._.._ .__....... ADDITIONAL COMMENTS _. _.._. . _. ......._. _. ._ Final Inspection by: _,.'rt_. . .. . ....... __....... ... ...._ ...... Date f�j .�t�. .. ... SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 13 24 1-'68 Rev. 5M 7/71 z u