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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT� i/ lCanrpsetein Triplicate) _ Permit No. 7 .. ...:_ : r . _ . .nPhis Permit Expires 1 Year frons Date Issued Date issued -46-r- ...........Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the workherein described. This application is made in compliance with unty Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ...............CENSUS TRACT _ ..... Owner's Name ..... ..... ..•. Phone .' - fI_._ -...... = r Address ............................ .... .... ...-.. ... ...:__.t.. s._ti_.......CI .... - - 1. ,. 1Y Contractor's Name --:----- Q .......License{iI?` c ]/,. 1--- Phone ...=I.___.� . Installation will serve: Residence©�rtment House❑ Commercial❑Trailer Court ❑ Motel ❑Other . t � � ' Grt-� Number of living units:__�../.__ Number of bedrooms .;......_Garbage Grinder:, lot Size . _�.................................. ;!I Water Supply: Public System and name � = l ................................__.........._-_.-............... ,------........................private} '- . Character of soil to a depth of 3 feet: Sand I] Silt l3 Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam❑ , Hardpan p Ado Fill M6terIa if yei,type (Plot plan, showing size of lot, location of system i relation to wells;buildings, etc. must be placed an reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted If public sewer is available within 204 feet,) PACKAGE TREATMENT [ I SEPTIC TANK I.j _ � -- Size... , ----•-.. .---•---•-•-••--•---.._,.;Liquid Depth ._..--•.................... Capacity -----_--_--__--.. Type ..............:..... Material....................... No. Compartments .......................r ' Distance to nearest: Well ......_........................L:.Foundation _.__--_•---- Prop. Line ---..............___-. E LEACHING LINE { j No. of Lines .............:.:........ Length of each- line............................. Total Length ..._...................... D' Box T Filter Material ' ' .....:........Depth Filter Material ................................ Distance to nearest: Well .. . Foundation Property Line ................. SEEPAGE PIT { j Depth I.......-•-----__---• Diameter ..........:..... Number ............................. Rock Filled Yes ❑ Na 4 Water :Table Depth ...........••......................Rock Size ... ._......--••--------••--- Distance to nearest: Well ........................................Foundation ............:.-•-- Prop. Line ..................... REPAIR/ADpITION(Prev. Sanitation Permit ......:..-•-----••--•-- --_-- :--=" D0 ...:....-: Septic Tank (Specify Requirements)....:................ . x - .. ....:........... ...................... ._. ..... _ ..- Disposal. Field (Specify Requirements) ..f. i ........................ . ................ ---•-------------------•------ -•---- -----------•----••- ......... ------••--• ------••............ ...................... (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and-that the work will be dons in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the 'San Joaquin Local Health,District. Nonce_ owner or Men- sod agents signature certifies the following: "I certify that in the performance of the work for which this permit isissued, 1 shelf not employ any person in such manner as to become subject to Workman's Cornpensatio aws-of-Catifornla " � i Signed - ----------------------• -• •- ---- ............ Owner . BY ------------------•--- -�' ......................... --- Yitie --------------- ---- - (If oth an owner) 1 FOR PARTMENT &UIE ONLY � APPLICATION ACCEPTED BY,.._- ..._ ........................DATE BUILDING PERMIT ISSUED_-- - fc - •--- O_ A� ................. ... ..----•--•--•--_- .. .ADDITIONAL COMMENTS . ..-•-•-----•..............--......_._.-.__.......-- --..._ 'Final Inspection bDate __....................•...._...._..-------•_..._....._: ..:. ------------------------.......-. ' EH 13 24 1-68 Irv. 5M SAN JOAQ N LOCAL HEARTH DISTRICT 8/7h 3M .•5 [ 1.1