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,FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 7S- ,< '.......................m............I--------- (Complete in Triplicate) Permit No. ..................... ........................................................ This Permit Expires IYear From Date Issued Date Issued Application is hereby made to the San Joaquin local Health District for a per to construct and install the work herein described. This application Is made in cornlance with County Ordinance No. 549 and existing Rules and Regulations. 9�9 JOB ADDRE55/LOCATI N ......................... , "..-...:.. ... - .....".._.......................'_..........CI:NSLiS TRACT Owner's Name a ._ • -• ....................r.... _ Y----- ..._ .Phone.................................... ... -. Address ..........- .rte ��..-. -. ..... .. . .. ... .... .... .. ......... .....•_._. tit y . . ... lJ Contractor's Name . .. ...License # �ty�.. .,hy..Phone ............................ { Installation will serve: Residence Apartment House Commercial [3Troiler Court 13 Motel ❑Uther " .-_.T_. Number of living units:....J..... Number. of bedrooms ----7�Garbage Grinder ............ Lot Size ... . Water Supply: Public System and risme ..............................:................-:...---•--7....••-••--•--....-•••••--•---••-----•••----•.......Private Character of soil to a depth of 3 feet: Sand C) Silt❑ Clay j] Pert'❑ Sandy Loam p Clay Loam C ¢ Hardpan Adobe 0 Fili Material ............ If yes,type ....................... r _ F (Plot plan", showing size of lot, location of. system in relation to wells,.buildings, etc. must be placed.on reverse side.) I NEW INSTALLATION.- , (No septic tank or see age pit permitted Ifpublic sewer is available within 200 feet,) i � GG i PACKAGE TREATMENT ( ] SEPTIC TANK SIz--e /t.l. _-: Liquid Depth ................. Capacity ........ Type 44 -�-.. Materials.-... No. Compartments vZ.. .... tom`... Prop. Line --- -, Distance to nearest: Well .........e`- .�_._-.-_..•_•__Foundation ......La ?�.............. LEACHING LINT: No. of Lines ...... ... Length of each line. .... _._... Total Length _ ... r 'D' Box'..-.- --.- Type. Filter Material a� •... Depth Filter ,material .----1 .'f.............................:1 Distance to nearest: Well ...... � _ Foundation ..../.d- ..-..... Property Lute �r SEEPAGE PIT Depth .... �A Diameter _::5 0yNumber ........Z-....-_.. Rock Filled Yes M,- No C) . Water Table Depth -__ .-___..lid..f ................Rock Size.---��--.Y--------____Distance to nearest: Well.......... :, ..----_...Foundation .._:d Prop. Lina .mFl .. i r REPAIR/ADDITION(Prey. Sanitation Permit�# ................................. Date ) eO 1 SepticTank (Specify Requirements) -------------"-----_ ------- .................c.......:.............................................................-••-•--••••-••••-. DisposalField {Specify Requirements) --------------------------------------.......-............................ .......................................................... ----------------- ...................................-------•.............................-.._......................... .............................................I........................ I .............................................. ---------------------------..................................-..............................................._.. .............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. Horne 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 Workman's Compensation laws of'California." Signed / Owner 9 ---•--•--------------------------------••1 � �- By ........................................(. f .�: '• - ` FL'" -� (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ...•.....;� � ......•---------------•-----•------- ............I....................... DATE .... '_.a. .. 5. .._ ....... I: BUILDING PERMIT ISSUED _........... ---• . DATE ........................................ ADDITIONAL COMMENTS :......... . ._ ... - .............-------------------------------------------.-...---• ---- ---------------•.............................. ........-................................................................. ....................."......................................... _ ......... ...........................................................................--..........._..................................... f Final inspection by: .tom ..._ Date..... /... 7- �................. SAN JOAQUIN LOCAL HEALTH DISTRICT ^W E. H. 13 24 1-'b8 Rev. 5M •rt w W_ 7/72 3 A