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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT --- d---------- Permit No. 7_L_-_`��_-- (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 Count Ordinance No. 55499 and existing Rules and Regulations: JOB ADDRESS/LOCA N ---4--� �--� �_-------- 4,4�n r.�`'�___-'-----._CENSUS TRACT ------------------- •-- - Owner's Name L- - _- -------------------- Phone _ 3.61-.. Address -----------------_' -- ----- ------- - City ---- --------------------- Contractor's Name ------------- - -------- ------License # ---------:-------------- Phone ----------------------..._...- Installation will serve: Residence a_xp�artment House❑ Commercial :❑Trailer Court ;❑ Motel ❑Other -------------------------------------------- Number of living units:_-I----- Number of ednooms -----�J___�__Gaarrb ---------- _------------- -----------------•------------------- bage inder '' tot Size ___--_____________________________________ 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 ❑ 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 seepage pit permitted if public sewerA available within 200 feet,) m PACKAGE TREATMENT fl-j— SEPTIC TANK[ ] , Size____________ © _` _ �_.______ Liquid Depth __ _________________•.-__ Capacity ._-�`'k; Type __ _'__ Material___��__�_�^No.Compartments -___ . .. Distance to nearest: Well ___ ___________Foundation ------------ Prop. Line ----------------- ____ ___: N LEACHING LINE [ ] No. of Lines :_ _-_-_----- Lengt}_ e*,li �� _ .. Total Length ;�'_---�__________________ -- ---- 'D' Box _____- Type Filter Material --------Depth Fi ter Material ---- -----------------•.-/....... Distance to nearest: Well __� ___-__ Foundation ____�_I�______________ Property Line _____S.__.__......__ SEEPAGE PIT [ ] Depth --- ------�-___ Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No C] Water Table Depth ---------------------------------- -------Rock Size ----------------------..._..---- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------I SepticTank (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 becombject'4orkm 's Compensation laws of California." ,OiSigned ---------- ------- Owner BY ------------------------------------------------------------------------------------ ------------------ Title --------------- -- - -------------------- (If other than owner) DEPARTKqNT USE ONLY APPLICATION ACCEPTED BY -------- --- --- ------------------------ --------------------------------------------. DATE7Z— BUILDING PERMIT ISSUED -- BUILDING -----------------------------------------------DATE ------------------------------------------- ADDITIONAL COMMENTS ------------- ------------------•--- -------------------------------------------------------I- -------------------------------------------- - - --- �— -- ----------------------- ------- ---- - - ------- ---- Final Inspection by: p� j .rr --------------------------Date ----- = ------- JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M