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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT --------------------------------- ' . Permit No. U- -7 )Complete in Triplicate) z\ Date Issued,:5 --- __Z _!_Q. ___.______---------------------------------_----_------ This Permit Expires 1 Year From Date Issued 3 ' Application is hereby made to the San JoaquinLocal 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 u;es and Regulations: JOB ADDRESS/LOCATION .---- /G J`-_ /--1- ----- /_.�. __.-------CENSl7S TRACT ----- -------------------- Owner's NameC / F,,e-'--------------------- ---------Phone --------------------------------- Address --------- =---------------------------------------------------- City - = Contractor's Name ------ �f/�.� 1 #_ '-----------------------------------License #/_1W42-e0-__-- Phone -'1� 1 _.- Installation will serve: Residence Apartment House ❑ Commercial r7Trailer Court i❑ �M l—o Other -------------------------------------------- Number of living units:---- Number of bedrooms _�___--Garbage Grinder /VP.--- Lot Size _4?4LA9_41X ------------ Water Supply: Public System and name ______________-_-- � Private w'-----------------------------------------------------------------------•------------ Character of soil to a depth of 3 feet: Sand'❑ Silt(]• Clay ❑ Peat❑ Sandy Loam •❑ Clay Loam'o HardpanX .A6obe ❑ Fill Material ------------ If yes,type ---------------------------- w {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:P] Size------------------------------------------------ Liquid Depth ----------!'_/•--------- Capacity ---- ------------'-Type -------------V-e Material---------------------- No. Compartments ------ -=---. Distance to nearest: Well ______;-+: -__ r-______--_-___Foundation -.--__ _ _______________ Prop. Line --_-__ ---;----------- s r ,. LEACHING LINE [ ] No, of Lines ------------------------ Length of each line---------------------------- Total Length -__-_--______ -_---_---: _ 'D' Box Type Filter,Material --------------------Depth Filter Material _ # Distance to nearest: ,\(Veli----------------------- Foundation --.-.-----_-- ---------- Property Line ------------------------- SEEPAGE _-_--___-_SEEPAGE PIT [ ] rDept Diameter _'"__--_-__- Number __ "Rock Filled Yes ❑t/�No !❑ Water Table Depth------------�- ---------------------------Rock Size ----------------------- ADistance to nearest: Well-----------------------------------------Foundation -------------------4 Prop. Line -----------------_--- REPAIR/ADDITION[Pre..v. Saiiitation Permit#---------------- - ----------------------------- Date ---------------_-------.--_----_ } 4 i I Septic Tank (Specify Requirements) ----------k--------- �/ -_----+r--------- --------------------f---------------_- ------ -------------- 'Disposal Field (Specify Requirements) A:-iq'- U---_- -_-/_ -f--f�___fa _C1 _ _ _ _ --_-_- 2M--------------------------------- --- --- ------------------------------------------------1�1------------------- --------------------------------------------------------- -------- (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work willk be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin ocal Health District. Home owner or licen- sed agents signature certifies the following: "I certify that in the performance of 4he 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 ----------- ---- -------------------------- -------------------------------- Owner By --------------- --- ----- Title ---- ---- ----------------------------------- (I f of arl`Owner) 1 R FOR D AR ENT USE ONLY f177 Z_ APPLICATION ACCEPTED BY ------------- - DATE -n-- ----------------- BUILDING PERMIT ISSUED --- ',' - ------------------------------------------#-------------------DATE ------------------------------------------- ADDITIONALCOMMENTS ---------- ----------------------------------------------------------------- ------------------------ - ---------------------------------- ---------------------------------------------------------------------------------------------------------------------------------I----------------------------------------------------------3------------ ----------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- ---------- - - -------- - ----- ------ -- r ,. 74 ----------------------------------------------------------------- ----- ----- ---- ----- -- Final Inspection by: ------------------------------Date -i - ------- ----------- ------ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.