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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT _... Permit Na. -7 � 9 --- ---------------------- �� .. -- (Complete In Triplicate) Date Issued ..�....:�....:.. .............. ....................... This Permit Expires I 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: 3� '� S"{"" p9 pp 'G!eACT A ?a rOS i JOB ADDRESS/LOC AT N , .-----.-.- ts ._ cu ^-...... . .CENSUS TR !�3•- n T Owner's Name .... . .. . ..................................... ... ...........Phone ..........,................... ....._ l Address .._ �. r� . .._., - .../ -.. City . fi Contractor's Name -- •-- ---- '. .... ._.. License Phone Installation will serve: Residenc1partment House❑ Commercial ❑Trailer Court jJ i Motel'o Other ............................................ Number of living units:-.-_./.-__ Numberof bedrooms ...7:::�:Garbage Grinde ..__....._ Lot Size ...................................:........ .:... ...........Private ❑ Water Supply: Public System and name'. ' 1 ' Character of soil to a depth of 3 feet: Sand o Silt 0 Clay ❑ CJPeat❑ Sandy Loom oy Loam ❑ Hardpan I] 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 permitted if public sewer is available within 200 feet,) W , I Liquid Depth ............ PACKAGE TREATMENT [ ] SEPTIC TANiC; ] • Size.............•------:._...._........-•----• - -..._.........,�� ,4 Capacity --------- ---- Type .................... Material...................... No. Compartments .......................Do ------. ---Foundation ----......--_------- Pro . I � Distance to nearest: Well ----__�.................. P• Line ....... ............... LEACHING LINE [ j No. of Lines --------------- ----- Length ..of each line._____......___........... Total Length 1 D' Box Type Filter Material ..............Depth Filter Material ............................................! Distanceto nearest: Well ..._...__.*.............. I'ovndation . Property Line " Rock Filled Yes No ❑��" . SEEPAGE PIT [ J Depth -----•- ------ Diameter --------------- Number .___....._....-_......_--• Water Table Depth -----_ ---....----_--------------- ........Rock Size ................................ ® � Distance to nearest: Well ........................................Foundation ._.................. Prop. Line ......-----• .......... REPAIR/ADDITION(Prev. Sanitation.Permit# ----------------------------- --------- Date ---------- .......... Septic Tank (Specify Requirements) _ ----------- _ Dis o l Field (Specify Requirements ..4- _ � �•• 1 L - •-------------- - 3 j ( raw existing and required addition on reverse side) �J hereby certify that I have prepared this application and that the work will be done in accordance with San .Joaquin' County Ordinances, State Laws, Qnd Rules''and Regulations of the San Joaquin Local Hbalth.District. Home owner or IlcerlJ sed agents signature certifies the following: "I certify that in the performance of the worts for which this permit is issued, I shall not employ any person In such manner as to become subject to Workman's Cons ensation laws of California." Signed ------------_-•-------------- ----------- -- -- ------------ Owner = ... --------- By ------------------------ ------- ----------------- -------- - __ 7itleGG: . . '... (if other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------..: f -------------------- ..... -------- -------------• • ---------------------- -----------� DATE,...,,_...,._..... BUILDINGPERMIT ISSUED .--- . . --------------------- ---------------------- -•------------..--------DATE ....-._._.__------....... .............. ADDITIONALCOMMENTS --- • ----------- -------------------------------------------- ---------------------------------------- ........... -------------------------------------- -------------------- - -----------•--- ------- -•----------- ------•------.._...--•--------------------------------•-------------- ---------------- ----- -------------------------------••-................. .... `CST ----. .-- t5ate .�� ---�- ..----•-•--... _.. i Final Inspection by: __--------------- --------- L/ --- ------•........ _.... iH 13 2h 1-68 Rev. 5M SAN JOAQUIN. LOCAs_ HEALTH DISTRICT 8/7h 3M