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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ''//_` -----------------------------------_- Permit No. --7/- - (Complete in Triplicate) - __._________--1---1/_I _1_-__-_-________________ This Permit Expires 1 Year From Date Issued Date Issued _. _'_ 7"7 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 compJiaryce with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION J =?==�� ------------------CENSUS TRACT ------ Owner's Name .._,J / f? 7 /� - t L' --�-_1��(1,------- -- -f-��-- --��-1�_f�- -------------------------------------------------•-------------------Phone -=-------------=- - - - - --- Address ��-- �� l/L ----- --- ------ -- - -- ----------- Cit �- 1 � �` � -- -.-._--.•- ` � � --__- -_. _.Contractor's Name --- __Ont - / -___.License #�7o ' __ Phone Installation will serve: Residence M Apartment House❑ Commercial ❑Trailer Court !❑ Motel ❑ Other -------------------------------------- Number of living units:_________ Number of bedrooms _-_ ------Garbage Grinder _.---------- Lot Size __�7� 1 '`Jj�'�--�------------ Water Supply: Public System and name ---------------------------------•----------------------------------------------------------------------------.Private 19 Character of soil to a depth of 3 feet: Sand W Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material ------------ If yes,type ---------------------------- (Plot ------------___-_--._____(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 seep pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK [ Size----- -------- Liquid Depth ............. Ca acity � _ -C_1----- Type _�' t__1 Material_ t�3ff_L No. Compartments _--2.istance to nearest: Well __- C _________________________Foundation � '__________--___ Prop. Line : .______._____.___._ r LEACHING LINE No. of Lines __-��_ _________.______- Length of each line____ ---------- Total Length ................ 'D' Box ___/______ Type Filter Material;PC'4'/G-------Depth Filter Material -19--14e--------- . - Distance to nearest: Well ------- ---------- Foundation __1C-------------- Property Line 4-_................. SEEPAGE PIT [ j Depth -------------------- Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No 0 - Water Table Depth ------------------------------------------------Rock Size ------------------------------ Distance to nearest: Well - --------------------_--____--__.-,_...Foundation --------------------- Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------) SepticTank (Specify Requirements) ------------------------------------------------------------------- --------------------------------------------------------- Disposal Field (Specify Requirements) ----------- --------------------------------------------------------------- --------------- ---------------------------------------------------------------------------------------- --- ------ ----------------------------------------------------------------------------------------.. (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 Wor an's Compensation laws of California." Signed Owner -- ------------ ---- ------ -- -------------------- -- (r? ----- '- - BY '--- L--------_�---------------------- Title ---- (If other than owner) / FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -_-.._ t-8-.'� J .-�- - ------------------------------------------ ----------...------------. DATE ------------� -7 ------------...- BUILDING PERMIT ISSUED - - - -DATE ----------------------- ------------------- ADDITIONALCOMMENTS -------------- ------------------------------------------------------------------------ -------------------------------------------=--------------------------- ---------------------------------- --- ---- ---- ---- ------ ---------------- -- ------ - - - ---------------------------------------------------------------------,,-rr-��----------------------------------- -- -------------- -- ---- --- ----- -- - --- ----------------------------------- a-L -------- --- - - ----- ------- ----- - - --------- Final Inspection -------Date --- -------✓ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M C v