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--..FOR OFFICE USE: _ - - - -- -- R' APPLICATION-FOR-SANITATION"PERMIT"" =------------------------------------ ----- -----' - = 3 : (Complete in Triplicate) Permit No. __-7 --7Sa. I K/ --------------- This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local,Health District for a permitRo construct and install the work herein described. This application is made in compliance- -w' th County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ._ 1� - 7�'*// ----------CENSUS TRACT ___ I-_.. Owner's Name �l /y: .-.__ / ._-.Q 'v Address pD city , �u_ _ Phone •t t •. ,. y _. - - oil -------------------------------------- Contractor's y (� NameJ'111� 'S--------------License."', Phoned "7' J Installation will serve J Residence ❑Apartm ent•House❑-Co mmercial OTrailer Court i❑ Motel ❑ Other _!__�U+ .� ° Number of living units ______ Number of bedrooms Garbage Grinder __--- Lot Size ___ __ -tr- _ _ Water Supply: Public System aid name _______--_ I -- --- --------------------------------Private l� Character of soil to a depth of 3 feet: Sand'❑ Silt j] Clay ❑ p eat❑ Sandy loam ❑ Clay Loam :.. _ m.r Hardpan ❑ Adobe-❑ Fill Material ------------ Iflyes, type ------------_--------------- (Plot _____ _(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 seepa a pit permitted if public s�e/w is ava'table within 200 feet,j PACKAGE TREATMENT P� ' { ] SEPTIC TANK [ Size- - __ 7` !" __ Liquid Depth __7_0 _____-_ .___ _ ...1 Capacity p y Type"- ---R�- MaterialdTe<71— -� No. Compartments #� l ; rh \10) Distance to nearest: Well _ ------------------------Foundation _-. e�___r�;�_- Prop. Line _ __ LEACHING LINE V No. of Lines Length of each line__f_Q�.__ �- �"T,otalNle.n 'D' Box X�- .__ Type Filter Material 7t-p� __.Depth Filter Material 1-5?-- ------�______•_______�� /� f � Distance to nearest: Well _S[?_�____________ Foundation �_T__`t-t_---------- Property Line ---- - SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number -------_-----,-v-�---------- Rock Filled Y is '❑ No C l Water Table Depth ----------.-------------------------------------Rock Size ----------- t Distance to nearest: Well -------------------------------------."-FoundatioVi__ -------- --- Prop. Line ...............€ f•------- REPAIR/ADDITION[Prev. Sanitation Permit# -------.------------------------------------- Date -----------�E---------•-----_____j 9 Septic Tank (Specify Requirements) ' Disposal Field (Specify Requirements) ---------------------------• ----------- -------------------- ------ -------- ---------------------- =---- i raw existing and required addition on reverse sidej � e I hereby certify that I have prepared this application and that the work will be clone in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Lotal 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 e as to beco e s bject Wo n's Compensation laws of California." ' E �-c • sit � Signed _ ,,/� - ---- ' ------------I ----------- ------ Owner BY ---------- ' �C�f - r Title .44�' �' - - F _ ._ ._ _- I_ ______ (If other than owner) OR DEPARTMENT USE ONLY € APPLICATION ACCEPTED By - 5 DATE BUILDING PERMIT ISSUED - i-------DATE ------------ I--- T ADDITIONAL COMMENTS -- ---------------------- -- ! i;, € --- ----- - -------------------------------------------------------------------------- -- ------ ------------ -------- ----------------------- ------ ------ I I s -------- - ----- ----------- -------- ---- -- - 14 `_ Final IIN nspection by. �. ,f � _ Dat-e- ate SAN JOAQUIN LOCAL HEALTH DISTRICT sA E. H. 9 1-'68 Rev. 5M 1'