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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT - -------------------------------------------- (Complete in Triplicate) Permit No: 7_-------------- '-� � __----------.--- This Permit Expires 1 Year From bate Issued 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 compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATI N ._L� r9----CI M_J----- -- -- - --- CENSUS TRACT ----------�---------------- Owner's Name - ---- %e----- -- --- -------------- -------------- Phone - .7.-/. rrZ `i � ------� Address `'---------- / City --t--- f� °Z ----------- Contractor'ss�Name _- _- - - - _ - - .mac!_- _ - - -G'.License # l�: -- �-- -- Phone ..----- Installation'uiill serve: Residence Apartment House❑ Commercial ❑Trailer Court ;❑ ',, Motel F1 Other -------------------------------------------- Number of living units----- ------ Number of bedrooms ---i-------Garbage Grinder ------------ Lot Size ------ —________________ Water Supply: Public System and name ---------------------------------•---------------------------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand'❑ Sift❑ Clay .❑ Peat❑ Sandy Loam ❑ Clay Loam` Hardpan ❑ Adabe'❑ Fill Material --- .___ If yes, (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,) Wh 111 V PACKAGE TREATMENT f ). SEPTIC TANK �_ ', rze____ +___X___�_____.___________________ Liquid Depth . --------------- ------------ Capacity _-____-_____. - ,- 1' ' ; � - 4'-Type -� ^__------ Material '----- No. Compartments --- Distance _ ------------ Capacity --- i < f FDistance-to nearest: Well. _--.�0--------------F_oundation _{____��__"�_____- Prop. Line ___. __ -------- ' ______ ''� '-'I �". / I J LEACHING LINT: ,No.;of Lines __.__�----------------- Length of each line-�___� -----,.____ Total Length --- ............. .. D' BoxType"Fi[ter Material _K _____Depth Filter.Material ____ _______________________________ Distance to nearest:Well ___ o`fi________ Foundation ____ --------- Property Line. __ ter_ `'-_-__-:.___ SEEPAGE PIT [ ] Depth' _ .__ 'Diameter _____ .y ; Number' -----------------_---------- Rock Filled Yes ❑ No i❑ Water Table Depth ----------------------------k ---------.--__._...Rock Size -------------------------------- Distance,to nearest::Well _______________________________ ________Foundation ------------------- Prop. Line ---------------------- REPAIR/ADDITION(Priv. Sanitation,Perm it,#!------------------------------------------- Date .------------__-___-______________} Septic Tank (Specify Requirements) ---------------- - ` ------------------•------••-•- ------------------------------------------------------------ - ------------------------------- - I Disposal Field (Specify Requirements) ------------------------------------------------------------ -------`------------------------------------------------------------ T - r -----,.-------------------------------------- 11 - ----_-1. _(Draw existing and required addition.:;i�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 wort[ for which this permit is issued, 1 shall not employ'any person in such manner as to become subject to Warkman's Compensation laws of California." Signed -- - -------------------------------------- Owner ' BY - r---- --------------------------------- Title ----- ---------- - 1 J. (If ter than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -' - - ------ DATE _` `` ' --------------- BUILDING PERMIT ISSUED ------DATE =--------------------------- ADDITIONALCOMMENTS ------------------------•-------------------------------------------------------------------------- -------------'-'`------------ -------------- --------------- ----------------------------------------------------------------------------------------------_--------------------------------- ------------------------------------------------------------------- Final Inspection by: --------------------- ---------------------------------------------_----------•----- ----- Dafie "�� ° , z� SAN JOAQUIN LOCAL HEALTH (STRICT E. H. 9 1-'68 Rev. 5M