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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT --------------------------------------------------------- Permit No.7��----------- (Complete in Triplicate) -----------------------------------------------I------ Date Issued _ This Permit Expires 1 Year From Date Issued --____.-_. - �✓J: OSs—%tor-1 L� Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described..This applicationis made.in compliance with County Ordinance No. 549 and existing Rules and Regulations. JOB ADDRESS/LOCATION a._ ',�� l �� t-rpt : ''E 'IENSUS TRACT Owner's Name -------�,/r� -----'-�"---------47� -------------------------------------- -------------- --,-��-r------Phone ---------------------•------------ Address -------------- a ------/� ---- city �'``�'r t!r ,� ------------------------------------------- Contractor's Name ------ L- '`�"r -------- ----------------- License - -------- --- Phone Installation will serve: Residence ❑Apartment House ❑ Commercial ❑Trailer fort ;F Motel ❑ Other -------------------------------------------- Number --------------------- ----------------Number of living units------------- Number of bedrooms ------------Garbage Grinder ------------ Lot Size ----------------------------------------- ,i 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 .___-___________________ ! {Phot 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 sewer is available within 200 feet,) ! PACKAGE TREATMENT [ ] SEPTIC TANK Size---Yt__/0_¢__j----------------------- Liquid .Depth ----y--------- Capacity ----'O&-------- Type _-- Material--- -------- No. Compartments y---------------- l Distance to nearest: Well __4m_j-------------------------Foundation ---------- Prop. Line --�_-__ ........ --- r t LEACHING LINE ] No. of Lines -1------------------- Length of each line____-/ Len Q------------- Total Length .--fr{ --------••--------- R f c�fi 'D' Box 'Q-___ Type Filter Material _411 _E_______Depth Filter Material __{__-l__ _______________________________ Distance to nearest: Well _4-0------ ____---_ Foundation _- _- Property Line 6_-i_---------------- SEEPAGE ____________ _SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number ----------------------------- Rock Filled Yes ❑ No 0 Water Table Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well ----------------------------------------Foundation --------------------- Prop. Line -------------- ------- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date -_--------------------------------) SepticTank (Specify Requirements) --------------------------------------------------------------------------- ----------------------------------------------------------------- Disposal Field (Specify Requirements) ------------- -- ----------------------------------------------------------= , I � i - ----------------------------------- •--- ------ ------------------------------------------- i --------------------------- ------- ----------------------------- ---------------------------------------------------------------- (Draw existing and required addition on reverse side) l 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 beco e u ct to Wo®ma 's Compensation ws of California." Signed -- f� t'� Owner. BY ----------------------------- ----------------------------------------------------------- Title ------- - ------------------------------------------------------------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----- -------------------------------------------------------------- DATE fl-?- --•------------------- BUILDINGPERMIT ISSUED ------------------------------------------------------------------------------------------=--------------DATE -------------•----------------------------- ADDITIONALCOMMENTS -- ---- ----------------------------------------------------------------------------------- ---------------------------- ---------- --------------------------- ----------------------------------------------------------------------------------------------------------------------- ---------------- ---------------------------------------------- ------- ---------- -------------------------------------- -- -- e ----------------------------------------- --------------- -------------------- ----------- j Final Inspection by: z. ------------------------------------ Date l- ' SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M