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FOR OFFICE USE: , 4- ) APPLICATION FOR SANITATION PERMIT -----------------------------------•-------------- Permit No. _7-�--------------- --------------- _-------3. (Complete in 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 made in compliance with County Ordiance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .-- -- z." - /,--- U - --- ,-------------------------------------CENSUS TRACT ---------- ............... Name /'��.- �_l� SC. ' `----------------------------------------- Phone --------------------- - - ---- Address ---- 7--F ------------------------------------------------------------ --------. city i�' .... ------------...." ---------------- Contractor's Name ________ � __-/ .°` --------------------License #,,_/J%- ..�- Phone �aS -, � Installation will serve: Residence; KApartment House,❑ Commercial []Trailer Court ;❑ Motel ❑Other -------------------------------------------- Number of living units:--/----- Number of bedrooms _�_____-_Garbage Grinderx'�-_ Lot Size ', ,� �--__.............. Water Supply: Public System and name --------------------------------------------------------------------------------------------------------------Privat e 5e Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay loam ❑ Hardpan ❑ Adobe 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,) PjkCKAGE TREATMENT [ ] SEPTIC TANK; S' e__ , 'r _�"__________ _____ Liquid Depth �� _______....._____. Type'-/��/Material -f. --- No. Compartments ____'1-............ Distance to nearest: Well __ "r-------------------Foundation 1_�?617__-------- Prop. Line/'Z0401�....... LEACHING LINE XNo. of Lines ______/_____________ Length of each line__�,A�---------- Total Length/e-e................ 'D' BoxlAr--- Type Filter Material`�4,�.Depth Filter Material ae__� ----------------------------- Distance to nearest: Well _1�- �`'______ Foundation 00-x _______ Property Line .ter SEEPAGE PIT Depth _ i _ _ ___ Diameter�j�_--Y - Number - ----------------- Rock Filled Yes No 0 _�________________ Rock Size _'�- `� Water Table Depth ____U�3 Distance to nearest: Well ___I,/__ � ______ ______________Foundation Prop. REPAIR/ADDITION(Prev. Sanitation Permit# ____________________________________________ Date ______________--___-_____________- Septic Tank (Specify Requirements) - - - -- r----- .e-am--- ----._>----- --- --- ------ _ ------------------------- Disposal Dis osal Field (Specify Re uiremnts) _ l ------------ e -------------------------------------------------------------- ------------------------ -------------------------------------------------------------------------------------... (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, I shall not employ any person in such manner as to become subject to Workman's Compensator laws of California." Signed - - -- --------- -- -------------------------- Owner By ----- �� ---- ------ Title --------- f-� --- ------ ----------------------------- (If of an owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -----w �' -------------------------------------------- ------------------ DATE _10/-7/------------------------ BUILDING PERMIT ISSUED ------------------------------- = ------------------------------------------------------------ --DATE ------------------------------------------- ADDITIONAL COMMENTS ------------------------------------- ---------------------- ------------- ---------------------------------------------------------------------------------------- ------------ ------- -------------------------------------------------------------------------------- - ---------------------- - - - - - - - - - - ----------------•------------------------------------------------ ----------- --- - Final Inspection b ________-_Date ___�_a_6_ _ __ _ P Y - I7�- -- ---------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 4% E. H. 9 1-'68 Rev. 5M