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FOR OFFICE USE: APPLICATION FOR SANITATION PERM' (Complete in Triplicate) Permit No. 7 7.... -_-_ _ - - - Date Issued _021.7..y- ---------------------_-_ This Permit Expires 1 Year From Date Issued r Application is hereby made to the San Joaquin Locul Health Distric± for a permit to construct and install the work herein described. This application is made in compliance with �County Ordinance No. 54/9/and /existing Rules and Regulations: JOB ADDRESS/LOCATIQN .----- --7--�--�S�-Q----. -(_Yi.-----L- -C-- (� 1-1�_-L.L. ENSUS TRACT ----- -------- Phone --- Owner's Name ------ ._ .Yf - ---- - -r�P-/L't�SQt�_ -- - - -._ Address 5 ' ------ ------------ ----------------- City ----- /77 --7_-/..$. - ` Contractor's Name .- .J//7 _ --------- CI:7--------------------License # Phone Installation will serve: / Residence [ Apartmment House❑ Commercial ❑Trailer Court 0 / Motel F1 Other -----------_._--_-_---------------- " Number of living units:_--L--.-_ Number of bedrooms ___3._.Garbage Grinder _._____ Lot Size --- ._ --------.-------_------____________ Water Supply: Public System and name ----------PYE.`Qt -----_--_-_-_-._ . . .......Private �-- r Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay Peat❑ Sandy Loam fl Clay Loam [] Hardpan ❑ Adobe❑ 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 if public sewer is available within 200 feet,) ,; PACKAGE TREATMENT [ ] SEPTIC TANK{ ] . Size. ------------------.......--------------------- Liquid Depth ----;�--------- Capacity N P h' �zQO-------- Type ��'Y:4��Material---------------------- No. Compartments --2r_.-------...--- Distance to nearest: Well 0 --------------- -Foundation Q -- - Prop. Line -- J LEACHING LINE [ ] No. of Lines ----3--------------- Length of each line.-_ -[�..._ _ __l2 d_-....._--- N .-_... ___ Total Length N I D' Box Type Filter Material --- 2_.rVc`-.K1Depth Filter Material _----Z_r-i......_______---- .-_.... 0 Distance to newest: WellFoundation .lE�4l__.... Property Line L _�... SEEPAGE PIT [ ] Depth -2 S-_.-.__: Diameter _33.---- Number .._-- .-- ---_ Rock Filled Yes __ __ _Nao �Z L �i Water Table Depth __. ---------------------Rock Size _ :..___._____-_-_-___ r Distance to nearest: Well -----10P_'f --_-.__.__.._------Foundation --'Gd-t�---- Prop. Line ---------- REPAIR/ADDITION(Prev. Sanitation Permit# -.__-__- - ------------------------------- Date . ----------..-....---------------) Septic Tank (Specify Requirements) --------------------------------------------------------------------------------------------- ----_--- t' Disposal Field (Specify Requirements) ------------------ -------------------------- --- ------------------------ ----- s ---------- ----------- - -- --- (Draw existing and required addition on reverse side) 1 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, 1 shall not employ any person in such mannet as to become subject to Workman's Compensation laws of California." Signed - -- ----- - - -- ....----- ----__ Owner By -- r/-" -... _ _ Title ........ 91"tA*- .G Qy-- --------- --------- other than a ner) FOR DEPARTMENT USE ONLY cy/ APPLICATION ACCEPTED BY.- - -- ---- ------------- -------- DATE -- ---- _ ---�f :. BUILDING PERMIT ISSUED ------- -------------------------------------------------------------------------------------------DATE ---------------------------- --------------- ------ L ADDITIONAL COMMENTS --- - - - - - - - ------------------------------- ------ ---- ---------- ------------------------ ----------- ---------- ---- ---- - -- ----- ----- ---------- k ------------------ �'�----------`-'----- ------------------------ -----�-"� �'-----_-----------_-_-_-- - - ----- . .. Final Inspection b P Y: .. - -. p` - - ----------- ------ Date 00-0c�: - -- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M