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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ------------- - ='� ------------------------------ S (Complete in Triplicate) Permit No. _7________ ________________________________ r 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 made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION _0715',P.-------- --------�--�'`--``----� . -------•-- ------------CENSUS TRACT ---- - Owner's Name -- - Phone - -------• --- .-------------- Address -, .� -- ------ City - - ---------------= --------------------- --------------------_ Of— Contractor's Name --1 ,----��- ---------------------------------------------------------License #t_� `�° »__ Phone �"�_._y' Installation will serve: R sidence ®-Apartment House L❑ Commercial ❑Trailer Court ;❑ Motel ❑ Other ---------`--------------------•---------•--- k Number of living units:----- ----- Number of bedrooms _41------- Grinder-- 1___?___ Lot Size __ t'1 � ______________ _ Water Supply: Public System and name - -------------------------------•------------------------------- ------------- Private . Character of soil to a depth of 3 feet: Sand'❑ Silt[T" Clay E]'- Peat E] Sandy Loam; Clay Loam;❑, - Hardpan ❑ Adobe ❑ Fill Material ------------ If yes,type ____-______________________ (Plot plan, showing size of lot, location of system �n relation to wells, buildings, .etc. must be placed on reverse side.) NEW INSiTALLAT[ON: {No septic tank or seep a pit permitted if public sewer is available within 200 feet,} PACKAGE TREATMENT [ ] SEPTIC TANK' PREM, �_ __ -------------- Liquid Depth -----------------_--- Ca _ ____-...... >� Ca city _�i%a_e_--_--- Type PREM, Material__ �__ No. Compartments • istance to nearest: Well _��t�_r_________________-------Foundation Prop. Line ------- --- LEACHING LINE No. of Lines __( Length of each hne__t_, _ __ ___ Total Length -------------- ---------------- ' J yp Material 11 �=i D' Box __�________ Type Filter Material Depth Filter__ - _ �_`--._-- r r � Distance to nearest: Well ___/_QQ ------- Foundation ____ Line. -------------- r ' 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) ______&e!_]__Z=_7 RJ��.�---�---------� ------- _ :_ ---------------- 670----- DD = ' ezco_�77W/ -------------------------- - -------------------------------------------------------------------- ----- - ----------------------- - ------------------- ,(Draw existing and required addition on reverse side) 1 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 become subject to Workman's Compensation laws of California." p + a? 1, e Signed ; --------------------- ---------------•------- _ Owner By --------------------------------------------------- -------------------------------------------------- -- -Title :--------- ---- ------------------------- ---------------------------- (If other than owner) y FOR DEPARTMENT USE ONLY -4 APPLICATION ACCEPTED BY --7ri-9=------------------------------------- L ------ ----- --------------- --------. DATE ------ - Z----- 7-s---------- BUILDING PERMIT ISSUED ------------ -- -------------------------------=---------------- DATE ---------------------------------------- ADDITIONAL COMMENTS ------- ----------------- --------- --------------------------------- --------------------------- ---------- --------------------------------------------------------------------------------------••- ------------------- ------------ - - - -------------------- --------------- ------------FinalInspecDate - SAN JOAQUIN LOCAL HEALTH DISTRICT n E. H. 9 1-'68 Rev. 5M