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FOR OFFICE USE: APPLICATIOfv FOR SANITATION PER-9T - Permit No. (Complete in Triplicate) +' 7� ..../ __...---- This Permit Exoires 1 Year From Date Issued Date Issued ..S/,9_-.7/ 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: cry ® p JOB ADDRESS/LOCATION St-7--------/T- _ %&V -- -. CENSUS TRACT .-._ __ .._..___--- Owner's Name _. "0411--i` �/ - - Address ._ � _ ----- City ----- ---- ----------- / ,p Contractor's Name 1 S G. � �_ __._License 4Phone mow A AK Installation will serve: Residence,2�Apartment House❑ Commercial ❑Trailer Court ❑ Motel ❑ Other -- -- - - - --------- Number of living units:---- Number of bedrooms .__-Garbage Grinder -/ire Lot Size _/ . -.-- _ -.-._-_______ Water Supply: Public System and name - ------------------------ -------------- ------------ --------------- -- ------------- --------- --_----Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ 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.) Q NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ I SEPTIC TANKAK Size.. rs1� ,�1�5�,� ---------- Liquid Depth / .. Capacity/0?W Typ Materiej�No. Compartments _ Distance to nearest: Wel __ ®_______________________Foundation/10� _ __ --- - Prop. Line 297c... ---------- LEACHING LINE jigNo. of Lines -. _ 2 _. Length of each line ____5767__ ________ Total Length ..I._.__.<6 ................ 'D' Box Type Filter Material Depth Filter Material , __ ____________•----____.- Distan e to nearest: Well ...... Foundation - -//_ . -.___ _._.__ Property Line ._---------_____________ SEEPAGE PIT Depth 9577�_ Diameter � -_ Numbe _L .. _ . _- Rock Filled Yes. ] No Water Table Depth ...1300-_---_--.-___________________Rock Size .Cl....---___. Distance to nearest: Well �(��. - ------.._.--------Foundation ... .....-- Prop. Line REPAIR/ADDITION(Prey. 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 t e performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to becomes ct to W r an' mpensation laws of California." Signed -------- Owner BY - - •• _.. ............. Title - ----- - - (ff o r an owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ..... ._._� ...................................................... DATE _.5-\L>'�l•---- ----•--•------ BUILDING PERMIT ISSUED ----•- ----------------------------------------------DATE ........................................... ADDITIONAL COMMENTS ...__-._-___ .................................... —:� - -----------------------------------••------•-•-•----------- ------� �� ...- -: .._. --- �---- ------------------- ---------- ------ Final Inspection b P Y� - �- -- - . ...... . .. . ... ----------Date --------.o...'---.......------•-••--••--•- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M C