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FOR OFFICE USE: -------------------------- APPLICATION FOR SANITATION PERMIT ------------------------------ (Complete in Triplicate) Permit No. 7_Z= __`�_U / { ____________ This permit Expires 1 Year From Date Issued Date Issued -_ -------------- Application _�___�__L - l �/ 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/LOC TION,___#�-_(�l_I--__a_. --------- - ----------------------------------------- -----------CENSUS TRACT -------------------------- Owner's Name _L . - - C --- � Phone --- ------------------------ --- Address --------------------- - - - - - ' - --- city _ j --------------------------------------- --- __._Contractor's Name License # / �Y /_ _ Phone Installation will serve: Residence ZwPartment House❑ Commercial ❑Trailer Court Motel ❑Other --- Number of living units:_-____�___ Number of drooms ______nGarbage Grinder _1L`__ Lot Size ___-____-_____________________________ Water Supply: Public System and name ______--_ _._ ------- ---. -?--=---•----•--------------------•-------------Private ❑ Character of soil to a'4pth of 3 feet: Sand'❑ It❑ Clay Peat❑ Sandy Loam ❑ Clay Loam ❑ l�,3 a Hardpan ❑ Adobe ill 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,) O PACKAGE TREATMENT { ] SEPTIC TAN k` Size_` _---------_ Liquid Dep�s � Capacity -------------------- Type ------------------- Material--------------------- No. Compartments ------------------ -__- N Distance to nearest: Well __________ ____--_____ :_ ____Foundation -------- ------------- Prop. Line ______________________ LEACHING LINE No. of Lines --------- -------- Length of each line----,_3_l _/--__.____ Total Length ............. D' Box ""'V --- Type Filter Material _' _�__CJ------Depth Filter Material ___ , ______________________________ Distance to nearest: Well ___----_________ Foundation/-_O__ _______________ Property Line .: ___ A E PIT L l Di`eF e r -------------- Number -------/---------_------- Rock Filled Yes Water Table Depth --------- ------------------ Rock Size �,�2 ?�_ Z, Distance to nearest: Well --------_---- ---------------Foundation , _�____ Prop. Line `�_�______________ REPAIR/ADDITION(Prev a Sanitation-Permit.# -------- ----------------------------------- Date -_______-____-______-_____________) 4 Septic Tank (Specify Requirements) --------------------- - Disposal Field (Specify Requirements) ;-----------------------------_----_' ------------------- --------------______________'_____i______-_-______________-________-_. ___________________ ______ _____________y.___ -____-______-.____-_--____-___ r ' (Drawlexisting and required addition on rev]rse side)--------------------------------------------------------- 1 hereby certify that I have prepared this! application and that the work will be done in accordance with San Joaquin County Ordincinces, State Laws, and Rulei and Regulations oUthe San Joaquin Local Health District. Home owner or licen- sed agents sigiatvre certifies the following: "l 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 C*lifornia." Signed ------------ -- -- ------- -- --- '---- ---- Owner � By ,_ l -- --- Title '�.t'�. - - =L..�' (I of r than owner) FOR DEPARTMNT USE ONLY APPLICATION ACCEPTED BY __ - DATE 7 BUILDING PERMIT ISSUED __--- __ __------ _ _ - ----------- -------- -- DATE - --------------------- ADDITIONAL COMMENTS ____---_ - -------------------------------------- ------- ----- ----- Final Inspection by: ____ --------------- ------------------------------------------ ---------Date ------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M