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FOR OFFICE USE.. � APPLICATION FOR SANITATION PERMIT --------------------------------------------- (Complete in Triplicate) ------------- Permit No. 7 -------------------------------------- 0 ____ This Permit Expires 1 Year From Date Issued flats 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/LOCATION . -- -_2 �5-- P.R0 -----------------------------------------------CENSUS TRACT 1.- � °__.... Owners Name �Q._dV-l9}_N__ /� CI : . __ ----__ Phone 37 .G- M r `- 5 q City Address . - - - Contractor's Name ---- --------------------------------------------------------------License'# ---------:-------------- Phone ---------------------------- Installation will serve: Residence ❑Apartment House❑ Commercial ❑Traifet Court ❑ Motel ❑Other --------------------------------------------,` Number of living units:______I--- Number of bedrooms _,.___.___Garbage Grinder ill--;?---- Lot Size -----------------.'_.--------------..________ Water Supply. Public System and name ---------------------------------- -------------------------------- '----------------------------- '------- Private ©� Character of soil to a depth of 3 feet: Sand❑ Silt fl Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam:ate Hardpan_ Adobe_❑_Fill Material /h'o �If yes,type ____._.___� `______ (Plot plan, showing size of lot, location of sysfem in rel tion to- wells, building's, etc. m st be placed 6n reverse side.) G NEW INSTALLATION: {No septic tank or seepage pit pei mitted if public.sewer is availabl within 200 feet,} AJ PACKAGE TREATMENT [ SEPTIC TANK'[ ] Size-------------------±"------ ------------- -- Liquid Depth ___-___________----.----- Capacity -= Type --------- ---- ----- Material - ------------------ N . Compartments -----------------=•--- Distance to nearest: Well Foundation -------- ____________ PropLine ---------------_------ LEACHING LINE [ ] No. of Lines _____________s;_/_ _ Lencth of each line____:--------------------------- Total Length,„_---------.___-_--___-____ 'D' Box ------------- Type Filter Material --------------------Depth Filter Ma erial ----------- ------------------------------•- y hi Distance to nearest: Well ___________ ___________ Foundation __-- -------------- ____ Property Line. ------------------------- SEEPAGE PIT [ ] Depth _ _ Diameter _-_ -----,=--: NumbeRock Size -- Rock Fidledl Yes E] No 0Wafe Tabfe Depth Distance to nearest: Well --------------- --_------ ----------------------------Foundation ------ ------------- Prop. , ne ---------_•------_---- REPAIR/ADDITION(Prey. Sanitation Permit# ________ - -------------------- Date ----------------- --------------- Septic ------------ Septic j Tank (Specify Requirements} -------------------------------s- ---------------------7-- ----------- I t -------- ------------------- + Disposal Field (Specify Requirements] ----- -=----------- ------------ -------- ' L ------------------------ -------------- A4 JZJ- ------ -------- ---- -----------------------_----- -------------------=--- ------------------------------------- - ---- --- on F- I hereby certify that,I have prepared thiseappl cakion and kthfarathe'r'work ,,reverse-side),. . ,will be done in accordance with San'.Joaquin Corny Ordin na cels,;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 th t in the performance the work for which this permit is issued; I shall not employ any person in such manner as to bec a subject to km s Compensation`laws of California:" ` Sign i _._ ._. Owner j -- --------------- ----- - -- - - --------- -------- ------- B ---- -------------- ---------- (if - .... .._ By Title - '(If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BYt Irl © '' DATE _-l_ 7-7 - ----- BUILDING PERN4IT ISSUED ------------------- -------DATE --------=----------------------- ------------------------------------------------------------------------------- --------- ADDITIONAL COMMENTS - -- --------------------- ----------• --- ---------------------------- ------------------------- ---I------ -------------------------- ---- --- --------------------- --- -------- - --- - -------------------------------------------------------------------------- --------- ---------- - - [ -------------------- -------------------------------- ------------ ----- - --- --- -- -- ------- -- ----------------- - Final Inspect; ------Date -- - ' -- -------- --- --- -SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M