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r FOR OFFICE USE: c APPLICATION FOR SANITATION PERMIT >: Permit No. -7 ---------- i6 (Complete in Triplicate) -------------------- ------------------------------------ ------------- This Permit Expires 1 Year From Date Issued Date issued _Z"__ ___------ I 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 v2z, ,010--------47- `T G A ..... -------------CENSUS TRACT -------------------------- Owner's Name . ' '�� ---------------------------------------------------_Phone Address ------ ---------------------------•--------------------------------------------->__. City' r ----------------------------------------------- Contactors Name __ .. '� / - . /�/�'�'_��,�___.License # Phone I Installation wil!`serve: Residence 19 Apartment House❑ Commercial :❑Trailer Court ;❑ Motel ❑Other - ------------------------------------------ Number ----------- -- -- Number of living units..---/----- Number of bedrooms - --_--Garbage Grinder .4/7_ Lot Size - _________.__. Water Supply: Public System and name --------------------------------•---------------------- ------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam,.❑ Clay LoamXP i Hardpan ❑ Adobe-❑ Fill Material ___________ If yes, type _________________,______ ]Plot Fplan, 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 seepage pit permitted if public sewer is available.within 200 feet,) i PACKAGE TREATMENT [ I SEPTIC TANK;( ] Size--------------------------------------------- -- Liquid Depth -------_---------------- Capacity _----_-___-- _ --- _-- Capacity ---------------- Type --------------------- Material---------------------- No. Compartments ---------__...... G Distance to nearest: Well ____________----------------------Foundation ---------------------- Prop. Line ----------------------%Y LEACHING LINE [ ] No. of Lines ------------------------ Length of each line---------------------------- Total Length ----------------------------0 'D' Box ----- ---_._ Type Filter Material --------------------Depth Filter Material ---------------------------------------- Distance to nearest: Well-------------------------- Foundation ------------------------ Property Line ------------------------M I SEEPAGE PIT [ ] Depth -------------------- Diameter ________________ Number ---------- ----------------- Rock Filler! Yes C] No [3, i Water Table 'Depth ------------------------------------------------Rock Size -------------------------------- ------..Foundation -------------------- Prop. Line ------------- REPAIR/ADDITION Prev. Sanitation Permit# -.__.______________________ v' istance to nearest: We __"_.____________ / ( --------- -- Date --------------------------•-------I SepticTank (Specify Requirements) ---------------------------------------------------------------------------------------------------------•----.,---------------------------- I Disposal Field (Specify Requirements) ---------------3- .f _ , " `---,�1 y_,, --- _ --------------- -------------- I ------------------ (Draw existing and required'addition on reverse side) I hereby certify that I have prepared this application and that the wo&,will be done in accordance with Son Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaq.4in-�Local Health District. Home owner or licen- sed agents signature certifies the following: ' "1 certify that in the performance of the work for which this permit is issued, I shalt not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed - --------------------------------------- --------- - - ----------- ------------------------- Owner Y ------------ -----/-- ----------- - {!f other tha ------- ---------------- Title ------------------------------------------- ---------------------------- i r,�f ner I k F R Pfi ARTMENT USE ONLY I APPLICATION ACCEPTED BY ----- - --------- - --- --------------------------------------------------------------------- DATE __z--Y -------------- BUILDING PERMIT ISSUED ------ - - -------- -- -- --------------------------------------------- DATE ADDITIONAL COMMENTS --- --- - ------ -- -- - ------------------------------------ - - -------------------------- -- -- - ---- ----------------- ------------------------------------------- -- =------------------------------------------------------------------------ ----------------------------------ection b -- , Final ins ��' p Y� ------ -- -- ------ - ------------------ - -- -------- ----=---------------- -- Date -----�_--�-'~�_�-----�_"_.�------ i SAN JOAQUIN LOCAs. HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.