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APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) This Permit Expires 1 Year From Date Issued FOR OFFICE USE: 7-7 ,2 --? o-o PARTMENT USE ONLY FO Final Inspection by: JV 7 Date p - i JOAQUIN LOCAL HEALTH DISTRICT r • • •-• • •In fl11 • Permit No. 7 )----893 • Date Issued 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 ma Mrpliance with County Ordinance No. 549 and 'existing Rules and Regulations: " V ..* JOB- ADi3RESSILOCATION— - CENSUS -TRACT-- ?2;4itc. 5. 913,4., Owner's Name Phone 5; Adcli-ess ' -• City Contractor's Name License # .g4e5iJ-./ Phone -26'4 P Installation will serve: • Residence 1)-4 Apartment House 0 Commercial 0Trailer Court 0 I Motel 0 Other Number of living units: Number of bedrooms Garbage Grinder Lot Size AO?) "41494'' Water Supply: Public System and narne Private Character of soil to a d'epth of 3 feet: Sand El Silt jJ Clay Peat 0 Sandy Loam Clay Loam r ' ., .., (Ploti plan, showing)size of lot, location of system in relation to Wells, buildings, etc.. must be placed on reverse side.) i , , s _ NEW. INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) 1 PACKAGE TREATMENT i,.[ ] SEPTIC TANK DC . Size ......4/O .h.l..../..Z.T. . Z"..-;::2 ' f Liquid Depth . 4cLor ,.. /.. .. . ., C Ca-pacity ./..loa - Type 42.7,.. - MaterictIe No. Compartments 9-- . ...L ,„ !. I ... „ : 1 ‘r Distance to nearest: Well .01.G/ e.) ?' Foundation 0‘) ' Prop. Line C LEACHING LINE tx 4 r No. of Lines i Length of each linegil:- / Total Length i 2.6/ r Type Filter Material sg- / 1 ....Box I Depth Filter Material " • w , , i Distance to nearest: Well.,..,244J r',._ .Fopndation .014:7 ' .-- ,. Property Line SEEPAGE PIT di -..• -N. Depth 0.,:::1 / Dilameter 3.3 1." Number g. -- iiock Filled Yes [Z No 0 NI Water Table'Depth .... .. ....... .._a{,./ / Rock Size -> A ,.;..• 1 I Distance' to n'eciresti Well -11 ---"6.-) '.. Foundation • aS:7 " Prop Line I 1 REPAIR/ADDITION (Prey. Sanitation Permit # Date 1 , Septic Tank Tank (Specify Requirements) Disposal Field (Specify Requirements) ...." 7..62 i "J I I hereby certify that I have prepared this application and that th _e work will be -cione- in -a- ccEidan-ce -with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- (Draw existing and required addition on re.sierse sidep . • •,.. _ __ .... . 1 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 Owner a....461„........z.g.;,c, , By . .-.-.., :i i t I e 411; (If other than owner Hardpanfl 7dobe 111- Fill .Material If yes, type DATE if— DATE . APPLICATION ACCEPTED BY BUILD1NG..PERMIT „ISSUED . .... •• ADDITIONAL COMMENTS A a. -leee'-e- - 2-