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EOR OFFICE USE: APPLICATION FOR SANITATION PERMIT / 7 --------------------------•---------------- Permit No: `- -- _-� ---- (Complete in Triplicate). + . Date Issued �--- -_---- This.Permit Expires 1 Year From Date.lssued 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 compliance with County Ordinance No. 549 and existing Rules and Regulations: O = ::_ _,;$CENSUS TRACT --------------•-----•----- JOB ADDRESS/LOCATI _---- - - t .- ------------ ------ Owner's Name ... Phone ----- Address -------------------- --7 �' +----- ----- -- ----- ----- - ------ City --- ------ --- - --- -- ------------------------ .� s__.License # -��'��yPhane -- Contractor's Name 4 Installation will serve: Residence Apartment House❑ Commercial :❑Trailer Court ❑ Motel ❑ Other -------------------------------------------- ; Number of livingunits:_---- ._____ Number of bedrooms -__ _--_Garbo e Grinder .____-.- --- Lot Size ____ :_r_ I g - ----- Water Supply: Public System and name --------------------------------------------- - -------------------- -- .-: ------Private Character of soil to a depth of 3 feet: Sand'[] Silt❑ Clay ❑ Peat❑ Sandy Loam'❑ Clay Loam Hardpan ❑ Adobe.0 Fill Material ------------ If yes,type------------------______________ z `1 (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) W ► NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT 1 ] SEPTIC TANK'[ j Size----------------------------------.---------------- Liquid Depth -.______-______-.__------ k Capacity ------------------ Type..-- 77=` -:=Mater'ial---- '- `-- ----- No..' Compartments : -------------- C , Distance to nearest: Wel4 --------------------------------------Foundation ------------------ ---- Prop. Line -------------- -------- LEACHING LINE [ I No. of Lines --- Length of each line-------- ----- Total Length ------------.__-_-__------___ 'D' Box ------------ Type FiltJr Material --------------------Depth' Filfer,Material -------------------------------------------- Distance to nearest: Well ____ -.__ ___---_-`. ati _ _ on __i_.____. f__``-Property Line ________________________ SEEPAGE PIT [ � Depth• -------------------- Diameter ________________FNumber -.__._..__-_.._.--_ - ' Rock-Filled Yes ❑ No i❑ 1 � Water Table Depth -- Rock Size Distance to nearest: Well ---------------------------------------Foundation?---_-_----- ----- Prop. Line ----------------.----. REPAIR/ADDITION(Prev. Sanitation Permit# ._______ - --=----------------------- Date -------------- ---.--.----------1 \ ' Septic Tank (Specify Requirements) ---- ------------------------------------------------------------------------- ----------------------------..--_•---------------------------- Disposal Field (Specify Requirements) -------------------------------------------------- .. ----- ------------------- ----- ------ -- - -r--------------- 7i ---- ---- -------- - (Draw existingand required add itioin n,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:T "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 t i By - ` -------------------------------------_--- ------------------- ---- ,Title ..- (If other than owner) �T _ FOR DEPARTMENT USE ONLY q APPLICATION ACCEPTED BY -- ----- - -- -- ---- ---- - - ------------------------------------------------------ ------ DATE -i - r°r/ --------------- BUILDINGPERMIT ISSUED --------------------------------------- ----------=- ------------DATE ------------------------------------------- ADDITIONALCOMMENTS ------------- -------------- - - ---------------------------------- ------------------------------------------------------------ ----- i ------------------------------------------------- --------------------------------------------------------- - - -- - ---------------------------------------------------------------------------D--a-Date -�.-__f Final inspection by: SAN ------ JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.