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FOR OFFICE USE: - - APPLICATION FOR SANITATION PERMIT ----- - ----------- Permit No.7 - �3 (Complete in Triplicate) ----------- _.__._.___._______ ___________________________________ This Permit Expires 1 Year From pate Issued Date Issued i 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 made in compliance with County Ordinance No. 549 and existin Rul and Regulations: � ( VV CAN �, ` ��lvL JOB ADDRESS/LOCATION P ------- ---CENSUS TRACT -------------------------- } Owner's Name -----�,M1,5�,l ------ ---------•--------------------------- -•-------- ----------Phone --------------------- ----•-•------- iAddress --------- ---------------------------------- - City _. / �' /✓ ti I Contractor's Name _ _/t� _.- _._____.$ _____ � -_ ` / License #,1.77 _ Phone �l/-Sa1'�---- Installation will serve-1 Residence Apartment House❑ Commercial ❑Trailer Court ;❑ Motel ❑ Other--------------------------------------------- Number of living units:____�___-" Number of bedrooms ----_Garbage Grinder .IV'D--- Lot Size -________________ S Water Supply. Public System and name ---------------------------------•---------------------------------------------------------------------------._Private Character of soil to a depth of 3 feet: Sand, Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ;❑ Hardpan ❑ Adobe.0 i Fill Material ------------ 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 tank or.seepage pit permitted if public sewer is available within 200 feet,) PACKAGE 7 10;1 r TREATMENT [ ] SEPTIC TANKSize . _______________ ___ liquid depth __ _----------------- L Capacity/o Type _ ____ Materials s&V4G, No. Compartments -- .____ _-. - w - i f Distance to nearest: Well --- -----------------------Foundation - - -------------- prop. Line __.t?------------------ LEACHING LINE [ ] No. of Lines -----;}__------------- Length of each line-------.�FaI----_----- Total Length _12.; a--r_ 'D' Box . SC __,Depth Filter Material _ _ -, ______________________ Type Filter MaterialO C T _ ionDistanceYop YLine ---------- = _ SEEPAGE PIT [ ] Depth --- --- ---------- Diameter ________________ Number ---------------------------- Rock Filled Yes ❑ No 10 Water Table Depth ------------------------------------------------Rock Size -------------------------------- r Distance to nearest: Well ---------------------_-------------------Foundation -------------------- Prop. Line ........__-._________- I r REPAIR/ADDITION{Prey. Sanitation Permit# ---------------------------------------I---- Date ---------------------------------_} Septic Tank (Specify Requirements) - 1 ---------------------- ---------------------------- ----------- -- --- DisposalField (Specify Requirements) --------------------------------------------------------- -------------------------------------------------------- -------------- ` ---------------------------------------- ---------------------t-------------,------------ ----------------------------------------------I------------- -- �:"-i I --- ---------------------------- - ----------------- - - - - - - - - - - - (Draw existing and required addition on reverse side} I hereby certify that I have prepared this application and that the work will be done in accordance with San Jaaquin 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 "I certify that in t performance of the work for which this permit is,issued,•I shall not employ any. person in such manner- as to become su ect Wo ma 's Compens6ti6n-la`ws of California." Signed -------- -------- --- - ------ -------------------------------------------------------- Owner -------- BY y --------- Title ----- --- ---------------- {I ther than owne FOR DEPARTMENT USE PNKY APPLICATION ACCEPTED BY ---------------- -- --------------------------- -- ------- --- -- -- DATE ---------------------- -B--U--I-L--D--I-N---G-- PERMIT ISSUED --- --------------------------------------------------- ---------------' ------------------D--A---TE ADDITIONAL COMMENTS - --------------------------------------------------------------------- ----------•----•----------- = ---------- a ------------- ----- -------------------------__r.__ _- - - -- ------------- - ---------- ------ Final fns ection b __Date --- --- ..4----------------------------- SAN . _ _ 4 p Y f -- -------------------------- SAN JOAQUIN LOCAL HEALTH DI ICT E. H. 9 1-'68 Rev. 5M, C