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FOR OFFICE USE: r* APPLICATION FOR SANITATION PERMIT � _ (Complete in Triplicate) Permit No. 7 - �. + This.Perml Expires 1 Year From Date Issues) Date Issued Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is made in mpliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOC TION ---` 1''r� - CENSUS TRACT ------------- -- Owner's Name ---- � '� --CZ Phone ---- �IVi f'� Address ....Y_ --- -�---------`--`-"-�"-�-- ---------------------------------- City --- - -- _ �"f-------------------------..........----.....-- Contractor's Name __. ______ '___'_ ____ - r -----1-------=--------License # --- Phone Installation will serve: Residence,TApartment House❑ Commercial :❑Trailer Court ;❑ Motel ❑ Other ----------------------- Number ---------------------Number of living units:---'/--- Number 'of-bedrooms ---a2 Garbage Grinder ___ Lot Size ®�___ _ aOd &)4_4&t r • Water Supply:;Public System and name ------------- ----- ----->i)r ____ 7 ---------—---------------------._Private ❑ Character of soil to a depth of 3 feet: Sand b Silt o Clay .❑ Peat❑ Sandy Loam -❑ Clay Loam :❑ Hardpan ❑ AdobeX Fill Material ____________ If yes,type ____________________________ t; (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 sewer is available within 200 feet,) U� PACKAGE TREATMENT [ ] SEPTIC TANK [ ] Size_______________________________________________ Liquid Depth ____________________,_____ 6\ Capacity --------------------- Type -------------------- Material---------------------- No. Compartments ---------_---- Distance to nearest: Well ------------------------------------Foundation ______________________ Prop. Line _______-__.-__.__ r. LEACHING LINE [ ] No. of Lines _______________________ Length of each line---------------------------- Total Length :____.-__•.._._.......__.. 'D' Box ------------ Type Filter Material ____________________Depth Filter Material _________________________•_--__.-_-..__-_- # ____________ Foundation __--__ Property Line Distance to nearest: Well ---_--____-- ---_---- - -- --------•--------------- F SEEPAGE PIT [ ] Depth ____________________ Diameter ________________ Number ---------------------------- Rock Filled Yes ❑ No .i❑ Water Table Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well ----------------------------------------Foundation --------------- ---- Prop. Line ...................... ' REPAIR/ADDITION(Prev. Sanitation Permit# .:......----------------------------------- Date ________.-_____-_________________) Septic Tank (Specify Requirements) - '•-------------------------- -- Disposal Field (Specify Requirements) _ ____ --------;114 _ ________- _ � �.� ►_______ - --------------------------------------- ------------------------------------------------- ---------------------------------------------------------------------- - ---- -------------------------------------------------------------- (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, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed --------------------------------------------------------------------------------------------------- Owner BY ------------------------------------------------------------------------------------------------------ Title ---------- ----------- - (If other than owner) FOR DEPARTMENT USE ONLY A. APPLICATION ACCEPTED BY --------=---------------------------------------------------_---. DATE 1 �� $- - BUILDING PERMIT ISSUED------------------------------------------ ----------------------- ---- - -----DATE -------------- ADDITIONAL COMMENTS = ---------------------------------------- -------------------------------------------------=-------------------------------------------------------------------------------------------------------------------------------------------------------- . T' , _______________________________________________________.._______________________________________________________________________..___________-____-„_-----_____.__________-______________________________ Final Inspection b -- �-9 _ = ------- - -------------------- Date ----------------------------- r P Y 1�� 1 Uf------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT • E. H. 9 1-'68 Rev. 5M