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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ------- -- -------------- -----•---------- Permit Na. -7�---�a�-� (Complete in Triplicate) -- ---------------------------------------------------------- -----"------ This.Permit Expires 1 Year From Date 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/LOC AT ' - C- r"= .cit CENSUS TRACT `F v -------------- ----------- ------------- ---------- Owner's Name ----- Ph Address -- -- -------- ---------R-� ._._..__. City ----------- ----------------------------------- ------------------------- -- - Contractor's Name 2ct ------- --------- - ----- Vii- --.License #&I—V_Y Phone t Installation will serve: Residen a Apartment House❑ Commercial .[7]Trailer Court, ❑ Motel ❑Other - ------------------------------------------ Number -------------------------------Number of living units:___-�___-" Number of bedrooms ___�_ �- -• ` :__Garb)ge Grinder _-__-- ----_ Lot Size ___________________ Water Supply: Public System and name..__ ---------------------------------------------------------------------•---••----------- ... Private , A . Character of soil to a depth of 3'feet: - Sand❑ Silt❑ Clay. ❑ Peat❑ Sandy Loam.,❑ Clay Loom ❑ Hardpan Adobe E] 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:s'3�.(Nd septic tank or seepage pit permliied'if public.,sewW !s available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK' Size-- /c _X___ _____ `=_r ___ _____ Liquid Depth __ _______________,_____ Capacity -j. �-_- _ Type ._ Material_��n `No: Compartments ____ j.....:..._ i t Distance to near st'Wel! :'.-----_ t�__ ________________Foundation _"--__ -- - � --____--Prop. Line ___ __-__-�......_ LEACHING LINE [M/No. of Lines -------I--------------- Length of each line----------110-0........... Total Length --------I__p_c'-_......__.. 1� `- r. 'D' Box ---__�--- Type Filter Material -_-_-_=�_E_______ Depth Filter Material _____(_t'_____________________________". Distance to nearest: Well ______ -- --------- Foundation ____LProperty p___,_.___------ Line - !!-!.&- � SEEPAGE PIT [ f Depth _-6-9.171---- - -___ Diameter ____ _ ___" Number _________ _____---____ Rock Filled Yes No I❑ Water Table Depth ---------------I�--1 r t/ ft -- rp --•- Rock Size X,------------ Distance to nearest: Well ._________�.�_______________________Foundation _.___�_Q__.__--_ Prop. Line _......___----------- REPAIR/ADDITION .______..._ REPAIR/ADDITION(Prev, Sanitation Permit# ---------------------------------------------- Date --------------.._.----____________) Septic Tank (Specify Requirements) :'------------------------------------------------------------------•-------" --------------------------- Disposal Field (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 f 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, I shall not employ any person in such manner 1 as to become subject to Workman's Compensation laws of California." Signed --------------------------- ------ Owner BY ---------- 1 _ Title __._ (If other than owner) F R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- ----------- - ------------------------------------------------------I-------- DATE - " -------------- BUILDING PERMIT ISSUED -------------------------------------- -------------------------------------- -------------=--------------DATE ------- ADDITIONAL COMMENTS --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------- Final Inspection by: - ----- 7----- ---------•------- -------------- ---------- ------------------------------------Dat �: '� ' .-------------- -- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev, 5M