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FOR OFFICE USE: ------------ - - APPLICATION FOR SANITATION PERMIT --- --------- " -------- -- (Complete in Triplicate) Permit No. 7Z.-`{/_7_-_- ------- ------ This Permit Expires ] Year From Dale 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,op.plicationTisrmade in compliance with County Ordinance No. 549 and existing Rules and Regulations: -rt►7/4r i' f r n i:5=!""i3:�1:r'S }�' y JOB ADDRESS/LOCATI NZ -- _ -------------°t_)��4�{/cc,Gl�lr_�� ...��n��CENSUS Owner's Name ---------- - Phone . Address --------------------- £2° a L/� �---------------------------------- City - r Contractor's Name ___. � c7_ � --------------------------------------License #4� �6S ��%� - -/0-.;- �--- -- Phone --------"------------------•- Installation will serve: Residence [�31 partment.House,❑ Commercial ❑Trailer Court Motel ❑Other --------=--- -----------------------------• Number of living units:--- ------- Number of b-drooms X1------Garbage Grinder' -1- --- Lot Size.� __-- - � r ----------•-------- Water Supply: Public System and name _-__L< _ -1.- _. r_,--- ---------•----------- ------ Private ElCharacter of soll to a depth of 3 feet: Sand'[] Silt❑ �Elay ❑ Peat E] Sandy Loam -❑ Clay Loam Hardpan ❑ Adobe Fill Material/1/'��_.__ r - - - 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,tan`k or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT { ] SEPTIC TANK ) Size--f --fY'�--��yy------ - ------------ Liquid Depth �/�--------------• Capacity J—q------. Type �� Material-C1�� h-o i-&_ No. Compartments P7--------- Distance to nearest: Well ---------------------------------Foundation --��--�---------- Prop. Line ----------------------- LEACHING LINE �tj No, of Lines #___--�_ -_ Length of each .line-- ngth 1Td_`_-_. s – Le ----- 'D' Box 4s- -- Type Filter Material --49-6,k- '__-____Depth Filter Material -_1�'1_______.._ ___ / -- - Distance toy nearest: Well ___.__-__---__j_____----- Foundation ___ � �--____--.__ Property Line _-�_ -__-_ SEEPAGE PIT Depth -.--A '' t...... Diameter __''___ Number ' ------------------- Rock Filled Yes [)''`No Depth --------- Water Table De �� p ------------------------Rock Size 7 Distance to nearest: W611 '; __________________Foundation -14?--1--------- Prop. Line -� --------•-••- REPAIR/ADDITION(Prev. Sanitation Permit# _------------------_------------------------- Date 1 Septic Tank fSpecify Requirements)----------) ---------- ---------------------- 1 Disposal Field {Specify Requirements) - ----------- --------------------------------------------------•---- - --------------------------------------------------------------------------------------- ------------------------------- ----- -- Draw existing and required addition on reverse.side) 4 I hereby certify that I have prepared this application-and that the work will be done in accoidance with SanJoaquin 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 subject to Workman's Compensation laws:of California." Signed ---- ------------------------ I_ wner ---------------=--== BY ------------------------------f: # v` --- --- Title of er,tha ----------------------- 3 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTEb __________ _ __________ __ �� BUILDING PERMIT ISSUED � -------------------------- - DATE ----------_-------__--.---------------- ----- --- --------------- DATE ADDITIONAL COMMENTS --------------- = t ----. L ---------------------------------------------- --- F ; ------------------------------------------------------------= ---- - ---------------------=------------------ ----------------------------------------------------- - 1 Final Inspection b P Y Date SAN JOAQUIN CAL HEALTH DISTRICT E. H. 9 i-'68 Rev. 5M �- j