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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT '`_ - e `+� Permit No. -7- -(°-------- - -------- (Complete in Triplicate ----------------------- s Date Issued - This Permit Expires 1 Year From 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 Ordinance `No. 549 and existing Rules and Regulations: Cdwy��_/,VkENSUS TRACT ---------------._..------- JOB ADDRESS/LOCATION'-'1��-11��f�i �-- - / - Phone Owner's Name -�fs�dl�i�'�--� --- -�.^��.�5--•---•-------------------------- -- 4 Address .[a_,-�Sc ZIY7--- ---- city •5�i/ t 'f ---••--••- ------ -------------------- --- Contractor's Name License Phone _'c�.. Installation will serve: _ Residence "I" Installation I railer Court-sC]•, Motel ❑ Other - �'r'�--- t ---•------ Number of living units_____________ Number of bedrooms ___-__._____Garbage Grinder _____.__--� Lot Size .______-__________-------------�- Private 171 # - fi Water Supply: Public System and name -------------------------------------------------------------- r Character of soil to a depth of 3 feet: Sand'[:] Hardpan [I -Peat El Sandy Loam -[I Clay Loam .E] Hardpan ❑ Adobe' Fill Material ____-_-_.-- If Yes,type ---------------------------- I - (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 flank or seepage pit permitted if public sewer is available within 200 feet,) SEPTIC TANK'[ ] Size---------------- ------ Liquid Depth ------ ---------• --------- �. PACKAGE TREATMENT [ ] ,� Material---------------------- No. Compartments ------•=--------•- I �7CGsTiFh� Capacity -------------------- Type - - ---- • Distance fid nearest: Well '-----_-_-' '-------Foundation ---------------------- Prop. Line ------------•.-------- ` } _ Length- 6f eac 4 , --.------ - -h line-----` -------- --------- Total Length ------------,��.- - LEACHING EINE [ ] No. of Lines ----------'--------- ._ � s _ Y f - - = 'D' Box -------- -- T Filter Materia ---------------•-- Depth Filter Material -------------- -----------. "- nce to nearest: We . ___ — ---- ` ll � Foundation ----------- ------------ Propery Line Dista ► __.____ Rock Filled Yes No i❑ l SEEPAGE PIT [ ] P ¢ 57 De th _- ------- Diameter -- -- - Number --__--- Rock Size Water Table Depth --------- ---------- ----------•---------- � �ezl_rk= - ---------Foundation f G?-- Prop. Line f✓c y Distance to nearest: Well ___- REPAIR/ADDITION(Prev. Sanitation Permit# ----------- -- ------- i �!. ------ ------------------------------------- ----------------------Septic Tank {Specify Requirements} �r /A --------------- .S =f1 Disposal Field^ (Specify Requirements) — V. -�...�� ----- (Draw existing and required addition on reverse side} U I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin 4 County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- a 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 become bject to Workman's Compensation laws of California." Signed Owner ~ # : Title . -= --- r 4 of er an owner) s Q F R DEPARTMENT USE ONLY ------------------------------------------------- DATE �f '7- t APPLICATION ACCEPTED BY ------ '._____ ______ BUILDING PERMIT ISSUED ---------- --------- DATE ADDITIONAL COMMENTS --------------------------------------------------------------------------------------- ------ ------------------ 4 ---------------- ; --- _ ----------------------------------------- -------------------- ------- ----------- --------- .------------------- _ ----- - ------ - Date --------- -- - - - -- --------------------------------------- - Final Inspection by: - - -- - - - - - - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M �°''