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i ° FOR OFFICE USE: t APPLICATION FOR SANITATION PERMIT yPermit No: -7-L-- - -- 7 -- (Complete in Triplicate) Z6 7 Date Issued -------------------- ------------------------ This Permit Expires ] 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 described. This application is made in ompliance ith Co my Ordin a No. 549 and existing Rules and Regulations: c - 6 JOB ADDRESS/LOCAT N - �� -� --------. CENSUS TRACT --------•----------------- Owner's Name ---- --��--- -- -- -----------------=------------------------- Phone ------------ Address -------- s �'`-� ?`-----=-------------. City - _ Contractor's Name _ ____ __� License +_` -- Phone�� ' ��`7 - --- -- ----- .Installation will serve: ResidenceD4-Apartment House[3--Commercial-:Trailer Court i❑ Motel ❑Other ---- --------------------------------------- ' y Number of living units:_----- _-_ Number of b' ms ___:Garbage Grinder _--_ Lot Size .,a --9� /a Water Supply: Public System and name ------ _- I�fJ_�------ -- ----------------------------------- --------Private E] Character of sail to a depth of 3 feet: Sand.❑ Silt Clay Peat,❑ Sandy Loam ❑ Clay'Lodm ❑ 4^ Hardpan E] Adobe- ill Material _�f ?_^If yes, type ---------.----------________ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc, must be placed on reverse side.),., O i NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,),.C� I, PACKAGE TREATMENT [ ] SEPTIC TANK S'ze-_=- _ : ___ -------------------- Liquid Depth --/_.__�_------ �' • Capacity `: Type _ Material o. Compartments �� Distance to neare/st. Well _---___ -- -:'-______Foundation .___ 0_F_____ Prop. Lin ------------------ - ________________ LEACHING LINE [ No, of Lines ------ ---------------- Length of each line--- --- - ------ Total Length -- --_F�21___�--------•- ____- Type Filter Material _ _ r--____Depth Filter Material ____-/Z_�___ _____________________ i 'D Box �� - Distance to nearest: Well _ __ -------- Foundation _ .O--f_-- __-- Property Line SEEPAGE PIT [ Depth }--_-_____ Diameter g-6--- -_ Number - - --_---- --- Rock Filled Yes No J❑ Water Table Depth ----- ----------- Size --- lL - Distance to,nearest: Well ___-_._. r=_________________Foundation _ G__- ----- Prop. Line ... - ------------ REPAIR/ADDITION(Prev. San itation',Permit# -----------------------------------=-------- Date ____- -______r------------------- Septic ------------------Se tic Tank (Specify Re uirements) , 4 Disposal Field (Specify Requirements) ------ _.. ___--- � -------------- -------------- ------------ ------------ --------------------------------------------------------------------------------------------------------------•------------ F _ __________________________ _ _ ----_.;_______--_-_-_._______-----------_,._______--_______----___________------_______-----_._.______--. ____..._________._------___ I (Draw existing and required,addition on reverse side) i 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." ' . Owner � Signed ----------------- --------------- ------ - - -- -- ----- ------- BY �' --- ------ -------------------- Title dZ, -- ------ --- - therthan owner). PARTMENT USE ONLY APPLICATION ACCEPTED BY . - - ------------------------------------------------------- DATE - ------ ',1.--6- --------- BUILDING PERMIT ISSUED -------- --- ------ -- -- ---=- -- - -------- ------------------------------------ --------------------DATE ------------------------- ----------------- ADDITIONALCOMMENTS -------- -- -- -- -- -------- -------------------------------------------------- -------------------------------------------------------- ---- ----------------- _ --------------------------------------------------------v ----------------------------------- = ----------------------------------------------------------------------`� Final Inspection by. = ---- ------------- --------- -Date ----- - - -- 7---------------- SAN JOAQUIN LOCAL "HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M "'