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FOIL OFFICE USE: APPLICATION FOR SANITATION PERMIT ............................. Permit No. 7.. —/..�� {Comple7o hi 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 mqde in compliance with Co my Ordinance No. 544 and existing Rules and Regu(at}ans: W &..o. ISG JOB ADDRESS/LOCATION �II" ... CENSUS TRACT 1...._ .. ............. Owner's Name ......_. 1 A^1 ! ©°.�` Ej I� Phone . 3 �� Addressh 4 -------------•-....------. .._.... . --- ........-•---- Ci ri ...: .A_�_ --------------------------- Contractor's Name -----------------------••------•-•-•---------------------------------------------------.License # ....-- --.._.....----.. Phone .............................. Installation will serve: ResidenceApartment House❑ Commercial OTraller Court Mote ❑Other ------- -----------•-------_-----_------ Number of living units:-----/_... Number of bedrooms ---,_...Garbage Grinder ...� . Lot Size a te..............�. Water Supply: Public System and name ....---•---.•--. ...Private Character of soil too depth of 3 feet: Sand o Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loom ❑ V; Hardpan❑ Adobe:0 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 permitter! If public sewer is available within 204 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK[ ] Size................................................ Liquid Depth ..................... Capacity ----------------_-- Type -------------------- Material---- .................. No. Compartments ------•----------_-•- Distance to nearest: Well ------------------------------------Foundation ----------_...---._._- Prop. Line ......_-_--------_. LEACHING LINE [ ] No. of Lines ------------___----___ Length of each line------...... Total Length ..._............... ........ 'D' Box ------------ Type Filter Material --------------------Depth filter Material --------._.................................. Distance to nearest: Well ........................ foundation ........................ Property Line ........................ SEEPAGE PIT [ ) Depth Diameter ................ Number ............................ Rock Filled Yes ❑ No C3 Water Table Depth -----•--- -----•--•-- -------____..........Rock Size ......................... ...... Distance to nearest: Well ----------------------------------------Foundation .-_---------..//_..._ Prop. Line ....------------_--. REPAIR/ADDITION(Prey. Sanitation Permit,# .:............••............................ Date Septic Tank (Specify Requirements) .......... .....................................................------------------------ ._4... Disposal Field (Specify Requirements) __--Aj -I ?.....__. --------4____ ---I.............. Y_ I - I ` (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. Horne owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for'which i permit is issued, I shall not employ any person in such manner as to becomp ublect to a Compens tion laws o Calif ia. Signed rs - - �.' CJ4 ...... 7 er BY �- ----- ---------------------------------------------------------------._. Title --------- --- ------------------------ ----------------------------- (.If other than owner) FOR DEPARLMJNT USE ONLY APPLICATION ACCEPTED BY •--------------- DATE / 1T� BUILDING PERMIT ISSUED .._.. -_-- ....------...........DATE —---- ----- -------- . ADDITIONAL COMMENTS�� A'y/_a�cc� - O._ . ......................•------._.._...--.........._...--_......_•_•____ .- _....f-----..l._.....O.-.._....._ ------•---..-...-------•-----------------._..._------ .__ .•-._____.__. -----------__________ _..._.............___ ______ ______________ _ _ ... - ...___._. Final Inspection b ...............Dat --<—.. ..- - -..-_--.._- III 13 24 1-68 Rev. 5)4 SAN JOAQUIN LOCAL HEALTH DISTRICT 874 3m