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i FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. 7 :.sSy I ............................... This Perrrtlt Expires ? Year From Date Issued - Date Issued --------------"-----. _.. .. o 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 compliaj/Co�nt Ordinance No. 549 and existing Rules and Regulations: Jos ADDR1ss/LOCATI N ..�. 1-�1J._.. . ::....(/.....-_... ... ...................................CENSUS TRACT .......................... Owner's Name ..... .... . . . ��........ ....,......Phone .................................... Address .,.:... �_. .._City ...:. �!�+ ................... ....-•---_. . , j Contractor's Name ---------- -.. ........ '? License # ./�� '�� Phone Installation will serve: Residence 9!rApartment House❑ Commercial ❑Troller Court ❑ ' Motel ❑Other 1. ............ ............................ Number of living units------/.... Number of bedrooms .____._Garbage Grinder ............ Lot Size ...�.° ...................... Water Supply: Public System and name -------------- ------ ................ ...................�........_.................._... .---. .............Private - Character of soil to a depth of 3 feet: Sand E] Silt[3Clay [3Peat 171 'Sandy Loam- Clay Loam ❑ E Hardpan ❑ Adobe❑ 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: (No septic tank or see ge pit permitted if ublic sewer is available within 200 feet,} ' [ 7 I ; � Liquid Depth ....44_J----............ PACKAGE TREATMENT SEPTIC TANK Size... ..... ....... ..... Capacity JcPAP Type r -_-- Material . No. Compartments ...................... � Distance to nearest: Well ------_4.p--------------------Foundation ---/0.-_-_......... Prop. Line ...A............... � LEACHING LINE No. of Lines _" ---___ - f ! [ �...--___--. Length of each line.______-lb.�2........_-- Total Length ..-/....Q.�?......__-•_-.. 'D' Sox .... Type Filter Material ......;5.2—_ .Filter Materia! .-..../.Q " �� Distance to nearest: Well _...._.1'f.�..,�_.._._ Foundation -....1.4..�.._.....`Property Line -. ... ...04 .......... [ } Depth /._ _ Di "ter An...LJ-A_ Number ......../..:............ Rock filled Yes No ❑ Water Table Depth ------------ _- ---• -Rock Size I � Distance to nearest: Well ----.._....ZQo_...................Foundation .......0�0_._..... Prop, line -.5................ REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ................................__J 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 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 as to become subject to Workman's Compensation laws of California." Signed ------------------------------- l Owner SY ---------- -------------------------- (if other than owner) _ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .................... DATE . BUILDING PERMIT ISSUED -------- ----------------- ------------------------------------- ------- --------- ".DATE .................. ---•- •---- ADDITIONALCOMMENTS ..........._------ -------------------- .....................__....... -----_------_---- --------------------------------------------- ............... ------"-------------------------------------------------- ._...__._..._-......---•- -""----••-------------------------•...-...__..... .... ..--.-......................... ------- "... ------ Final Inspection by: . � ?�......:. .........:7-------------------------------.-......_.._.......................... Date -1�- - .' ......... EH 13 2L 1-68 Rev. 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M 5