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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT --------------------- - -----le--s------ s - (Complete in Triplicate) Permit No. _ 7,a ... ..........----------------------------------------------- _----- This PermiFzpires 1 Year From bate 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' County Or inan a No. 549 and existing Rules and Regulations. JOB ADDRESS/LOCATION ------ ------ ------ ------ --- - --------------------------- CENSUS TRACT s a Owner's Name -- - ---- --- - ---- ------- Phone . 7�D Address ---- ---------------------------- --� f -.-----_ . City ------------------------------ Contractor's Name ------------------ ------- ----- ----- --License # 1_k0 �-/ Phone 7�0 --' rf 1 Installation will serve: Residence Apartment House❑ Commercial:❑Trailer Court;❑ Motel ❑ Other -------------------------------------------- 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'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ f 1Clay Loam ❑ Hardpan ❑ Adobe Fill Material ------------ If yes, type ___ ________________________ f 1�r (Plot plan, showing size of lot, location of system in relation_to�wells, buildings, etc.. must; be placed on reverse side.) r NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is availa@e within 200 feet,) PACKAGE TREATMENT { ] SEPTIC TANKX ze_____-�__1 _/ Liquid Depth -- ______. ._ i : - Capacity Type Material__ No. Compartments 12 - Distance to nearest Well ------S-Z)-' ............. Foundation Prop. Line __/O_F-A-________ LEACHING LINE Nod of Lines -------- ------------- Length of eac line--.----7 .-_____ Total Length _____70 ............ I pp D' Box .---------.- Type Filter Material -- :Depth Filter Material ---- p_______________________________• Distance to nearest:)Well __ t ._ '' '-____ Foundation ___ -------- Property Line. ---------------- F v t ; SEEPAGE PIT { ] Depth --------------------I Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No 0 Water Table Depth -----------------------------------------------!-Rock Size ------------------------------- IDistance to nearest: Well_------------------------------ — Foundation --------------- ---- Prop. Line ----------- REPAIIR/ADDITION(PrevsSanitation Permit#A_-'------------------------------------- Date ----------------------------------11 Septic Tank (Specify Requirements) ________________ --^-'---"" t G Disposal Field (Specify Requirements) .S, = ---------- -------------- --------------------- -------------I-- - ------ -------------•--------------- xt ----------------------=------------------------------------------------------------------- -•------------------ --------------------- - ------------------------- ------------------ ----------------------------- - = — ---------- ----- ------------ -------------------------------------------- _ (Draw existing arid-rMquired addition on reverse side) I hereby certify that I have pr`epared'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: x "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 Compen"tion laws of Calif6rnib:" Signed --------------------------- ----- --------------------- ------ Owner ,� , ,A-- ►�/h/ + 1 ' - Title --- - ----- ----------'------------------------------ -- ---- - - --- (If oth han owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 8 �s .---Y►'1---- ------------------- DATE ......a7.-/ff�T�------------------ BUILDING PERMIT ISSUED - - -------------------------------------------m---------------------PATE -------- - ------------------- ADDI�IONAL M, N � kr{ - F�Ldet �f 1ff �+ --- - '---------- 2 ---- ----�'L --------------------------- -- ------ ----------------------------------------- U - ---------------------------- - ------------------ --- --------------------------------------------------------------------- ------------------------------9- 11"W': ---------- -------- ----- ------------------------------------------------------------------------------------------------------------------------ Final Inspection by9? ---------------------------------------- ------.Date ------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M E