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FOR OFFICE USE: APPLICATION FOR SANITATION P--MIT (Complete in Triplicate) " Permit No. _7�.-f/O�. __________________----------_ ______-------_ 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 innccompliance with County Ordinance No. 549 and existing Rules and Regulations: Ir JOB ADDRESS/LOCATION ._1o�. jy? _,_ �_....[ tet._..-._----_-_._-CENSUS TRACT ..--------------- Owner's Name ........ - Phone -- - ----- - ------------------------------------- Address ----_---------- -------- ----r-r`------- .... ---------------•---------------------_- City . - �h-�FC.(� - - -- ----------------- r ^ Contractor's Name ---------40- ------- ----------- --- --------------------------------------License # P1,?,3-Q.- Phone 7.f_4/-.4 Installation will serve: Residence)<Apartment House❑ Commercial[]Trailer Court I] Motel ❑Other----------------•-•------•---------------- Number of living units:__------- Number of bedrooms .:_.Garbage Grinder __........ Lot Size - - -1----------- _ Water Supply: Public System and name ------------------------- ----•------------------------------------------------------------------------Privateer' Character of soil to a depth of 3 feet: Sand)] Silt❑ Clay ❑ Peat El Sandy Loam Clay Loam 0 � Hardpan ❑ Adobe J] Fill Material ----- If yes,type-----.---------------._---_- (Plot plan, showing size of lot, location of system in relation tor wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted 'iif//public sewer is available Within 200 feet,) /L I a_ PACKAGE TREATMENT ( I SEPTIC TANK'$ Size.._y.X.,rX.}r�------------------ Liquid Depth .:_yII-��'. --...,___- Capacity .' W------- Type .�Ci vu_4__ MateriaLNo.�Compartments ---a!sf._-j-:...... Distance to nearest: Well ------ --------------------Foundation ._.�Q.___________ Prop. Line _.. .--------_- 1 LEACHING LINE [ J No. of Lines _3-------------- Length of each line_..------- -Q-____-__ Total Length ----------1i1�d.............it t 'D' Box -_-^C.... Type Filter Material .. .-Depth Filter Material _____ ----------I----------- ........... _ Distance to nearest: Well ---- Foundation _________ Property Line ._, J-..-.-__.......- SEEPAGE PIT [ ] Depth ____________________ Diameter ---------------- Number _.-_--___._-------_____----- Rock Filled Yes ❑ No Q WaterTable Depth --- --------------------------------------------Rock Size ----------------------------•--- Distance to nearest: Well ._.------------------------------------Foundation ______-_-_--_._.. Prop. Line ........._..----- REPAIR/ADDITION(Prev. Sanitation Permit# -----------.-----_------------------------ Date _._....------.--------------------I 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 I.. 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 manner asto beco a su t,t1� 1 Malis Compensat laws of California." Signed ---- ............ ------" Y - Pt r ._ --- Owner BY - - - - -------------------------------- Title ---- - --------------------------- -------------- ------------------- (If other than owner) R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ........... --------------. -------------- ..... DATE ---3 -z-+ ....7-0 PERMITISSUED ._ --------------------------- - ---------------------------------------.......... -------------DATE -- .--- -------------------------------- ADDITIONAL COMMENTS ----- ----------- ------------------------------------------------------------------- ---------------._....---------------- ------....----- --- -- ----------------------------------------------------- - ----- ---- ------------------------------- - - - ------- -----------------------------------------•------------ ------------------------- ----- - F ._--...__----'----------- ------------------------•--•--- --- - - - -------------------.Date --- --jr Final Inspection by ---....7 .-- - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M