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r FOR OFFICE USE: -- APPLICATION FOR SANITATION PERMIT Permit No. 7 L. k -------------------- --- --- (Complete in Triplicate) 11 t 1 This Permit Expires 1 Year From Date Issued Date Issued ------------ - j� ------------------ - 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 existing Rules and Regulations: JOB ADDRESS/LOCATION ._._ - -, -- --------�_;?----------- ------CENSUS. TRACE �� _ Phone c1 - ---- Owner's Name M - 1� = ------- ------- - Address --�}-�_,/-�-- -�----- --- ��f --lz-L'-�`"----- ------ -------•--. City � �D_"-�� ------ Contractor's Name -- --- --------L= ' - ---------- ----------------- - License #�_Vr//r--- Phone _P�u`_ _ _:. Installation will serve: Residence 0 Apartment Mouse°❑ Commerci I :❑Trailer Court ',❑ Motel Other ______ Number of living units_____________ Number of bedrooms _-,7------Garbage Grinder ------------ Lot Size -------------------- Water Supply: Public System and name ----------------------------------------------------------------------------------------------------- ------Private ❑ Character of soil to a depth of 3 feet: Sand'R Silt 0 Clay ❑ Peat ❑ _:.Sandy Loam.❑ Clay. Loam_❑ Hardpan [❑ Adobe ❑ Fill Material ------------If yes, type ___________________________ (PI'ot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) �0 J NEW INSTALLATION: (No septic tank or see pa pit permitted if public sewer is available within 200 feet,) I .__.-_-_PACKAGE TREATMENT [ SEPTIC TANK [ Size_rq p , Liquid Depth _ r________________ Capacity 4� _6___.__ Type 4r;;,Y Material No. ,Compartments __ -- ----------- t ZNa. nce to nearest: Well __-- __ ___________________Foundation __,�0.____.______ Prop. Line __ __`___..LEACHING LINEof Lines -----2____._ ------ Length of each line-----7-o_r----------- Total Length ._ _� ------__________ 11 0 'D' Box --------- -- Type Filter Material ( __Depth Filter Material _____ ___________________________ Foundation ¢ � Distance to nearest: Well -----t) -�-�------------- Property Line ------ SEEPAGE PIT [ ] Depth ____________________ Diameter ---------------I Number --------.------------------- Rock Filled Yes ❑ No WaterTable Depth -------------------------------- ----------•----Rock Size -------- ----------------------- Distance to nearest: Well ________________________________________Foundation _______ ---------- Prop. Line _______-.______..__.. REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date --------.-------------------------) SepticTank (Specify Requirements) -------- ---------------------------------------------------------- -------------•---------------------------•------------------------------ DisposalField (Specify .Requirements) ------------------------------------------------------------------------------------------------------------------------------------- [ --------------------------------------------------------------=------------------------------------------------------------------------------------------------------------------------------------------- —,.."" ----------- - -----. (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 Joaquin 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 certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ---- e . --- ------- 1 ---------------------- Owner BY Titler " am -- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ____` 'i_ _-___._ - ------------------- DATE "-'. -- BUILDINGPERMIT ISSUED ------- -----------------------------------------=--==---------------------��------------------------DATE ------------------ ------------------------ ADDITIONAL COMMENTS ----- - --------------------------- - - --------- ----------- - --------- - - ------- ------------------ -4 ------------------------------- ------ ------ -- - -- -' -- -- --- - - ----------- --- — ---- ------------- -- Final Inspeio - - ------ Date --------------- 't SAN JOAQUIN' LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M `-'