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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -7 (.3 Permit No. ..................... .......... .................... ;? (Complete in Triplicate) .....................................• Date Issued ._. A7- 7� This Permit Expires f Year From Date Issued Application.is hereby made to-the San Joaquin Local Health District for a permit to construct and install the work herein descr;b*d .This a tic on ' gde in compliance with Count Ordinance No. 549 and existing s gnd Regulations: E t�l� /�', flF ....CENSUS TRACT ..... ... JOB ADDRESS/LOCA ION _. �'•�.� ..... ..1. _Phone . :.. �a.1......... ... . .. .... Owner's Name .. AM. I'k.P. ----�J3�!i.1 f�. C! I e�/......%f. City - 4. LOBI/ ....................................... -•--- 1 Address •---•-•. / .3 ,r� ---.License _ - ... ......__ Contractor's_Name _1&71-4 ltl 1� .. _ - Phone Installation will serve..— ~Residence ❑Apartment House❑ Commercial ❑Trailer Court ❑ Motel ❑Other _...----•-......---•- •------•••-•-•-•--•. Garbage Grinder _._.__ - - - Lot Size --------------- ....... Number of living'ur��its:.._._J.._.Number of'bedrooms .:F_--• l ❑ N Water Supply: PublicSystem-and name .....-.:..:._` ------- --------------_----------------------•------••-......--•....... Private 01 Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay El Peat❑ : Sandy Loar>< Clay Loam ❑ f Hardpbn ❑ Adobe.❑ Fill Material.............. If yes,type ......................... -.- i (A (Plot plan, showing size of lot, location of. system in Tela#ion.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 204 feet,) co �� /�17 -y' �... Liquid Depth �.... PACKAGE TREATMENT [ SEPTIC TANK Size.....--- --- . ..._..._. Capacity . yp ��`'�' �s Material... ''`No. Compartments ....:.......... G Distance to nearest: Well --_I_ 4_•--•-•Foundation ..fQ............. Prop. Line . -- •---••-••...... I -- Len th{of each line._..��_.I..._...__... Total length `d...-=_•........ } LEACHING LINE ( ] No. of Lanes .�?..-.---•.•••---- 9 - _ .:.Depth Filter Material • . Type Filter Material ............................................. I4 Distance to nearest: Well .__...'........ . ...... Foundation .....------•- :•_. Property Line ...-- .:.:..:.._:..::. . Rock Filled Yes - No. SEEPAGE PIT [ ) Depth .................... Diameter ................ Number __...___...........— ❑ Water Table Depth ... ......•• ----..Rock Size ................................. -------•-- ---.:.... Distance to nearest: Well ...__.... 1....................... ... Foundation --•------------ ---• Prop. Line ..... a ......... Date ..........:....................... ' REPAIR/ADDITION(Prev. Sanitation Permit# ......•..... --•---------•••- Septic Tank (Specify Requirements) ................... •--__----..... _--_- .............................,-............................ Disposal Field (Specify Requirements) .......................... ------...---•..--....--...._.. ...............................................................-------- ------------•-•- ................ ...................................... ---------------------------- .................... ----- ---- _ ------ - - ----------•-- ----•�- - . . .... .... (Draw existing. an- -d required addition an reverse side) _ .. .1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Homs owner or liven- 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 Wor it' ompen ion laws of California." Owner -Signed ----------- _------ ...... - -...—Title ......... ...... .. ... .. .... .. - ---------- s (if other than owner) i y OR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ...� -- - -- ---•--••----•••• •..... . DATE ..__ '....:. r -•-• - DATE _.....:.............................. BUILDING PERMIT ISSUED ........... ::..........•-•.._... .............. --- ADDITIONALCOMMENTS ...................... .•--...........--•--•--••----••-•---•--..... _ k ........_........................ ... ...........•-•--.._.....v................-•---•• ----- ----------------•---....---.....----•-•----.............. ------•...... ._....._. _..... ----....: .............• --- -••-•-----•-••-----.._.._................_....................-•Date ....._.....- Final Inspection by:, SAN JOA UIN LOCAL HEALTH DISTRICT 7/72 3 M