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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete iri Triplicate) Permit No: 7/-S-72 ----- � / ------------------ Date Issued -------------------- -__V_-_--__ _________________ This Permit Expires 1 Year From Date Issued / Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. This application i's"-made in'compliiancee--with'County-Ordinonce- No.-,549--and-existing -Rules and Regulations: JOB ADDRESS/LOCATION 1 .--� �- --------------CENSUS TRACT ---------------------_---- Owner's Name -------�.y.Q -----------Z�V_1U-------------- ----------------------- -----------=---------------------Phone --------------------••---------.---- Address ---------- ---�D.-G. ----- ----------- _.__.... City ---------------------------------------------------- Contractor s Name ----- --- ------.License # ---- ------------------- Phone -------------- Installation will serve: Residence Apartment House ❑ Commercial ❑Trailer Court ❑ ' Motel ❑ Other -------------------------------------------- ,qq Number of living units:--/-------- Number of bedrooms ------Garbage Grinder .- Lot Size ----lL� � �__-_------ Water Supply: Public System and name -------------------------------------------------- -----------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam Clay Loam;❑ Hardpan ❑ Adobe ❑ Fill Material ------------ If yes, type ____________________ ______ 1 I - (Plot plan, showing size of lot, location of system in relation to, wells, buildings, .etc. must be placed on reverse side.) %V NEW INSTALLATION: (No septic tank or see pa pit permitted if public sewer is available within 200 feet,) S PACKAGE TREATMENT [ ] SEPTIC TANK-[ Size____________________________ --____ Liquid Depth ------ ---------- NJ Capacity _J�-Lw_____ Typee _4,"_ __ Material_�_�tr��No. Compartments ____-�_____________ � Distance to nearest: Well ____CSI ______________ _______Foundation ___l6)____________ Prop. Line .....!�.�---- _____. LEACHING LINE [1ZNo. of Lines ___. ______________ Length of e/ach ine______, W----__.______ Total Length ------ZZZ....._....__ 'D' Box _--- Type Filter Material--.f___ ..Depth Filter Material -------- l__ --------- Distance to nearest: Well ______t5 �_______ Foundation ______6_ I � � ---------- Property Line .----�-•-•--•---•-•-- ' SEEPAGE PIT [ ) Depth., ---------------,._,_„Diameter _______--__-___ Number _.________________________ Rock Filled Yes ❑ No i❑ Water Table'Depth ---------------`-------- ---------- -- •----.Rock Size -------------- ------- - Distance to nearest: Well --------------------_ _,_-Foundationr-------------------- Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# --------------------------------- ---------- Date ____________._____________________} Septic Tank (Specify Requirements) ------------ --------------------------------------------------'------------------------------------------------------ Disposal Field (Specify Requirements) ----------- -------------------------------------------- -------------------------------- �.._ 4 ______________________________ ___+ _ ------------------------------------------------------- (Drd-w-exist'ing..and_required addition on reverse side) s I hereby certify that I have preparedr,this application and that the. work Will. be done in accordance with San Joaquin County Ordinances, State Laws, and Rules-and-Regulations of the Sari•Joaquin Local Health District. Home owner or licen- sed agents signature certifies the _ "I certify that in the performance of the work for which this permit is issued, I shalI-not,employ any person in such manner as to become sub' orkm_ ''s Compensation laws'of California.” , ,r f Signed - -------_ Owner By ------------------------------------------- - ------------------ ----- ----------------------- -------- Title --- ------------------------'_4--------- (If other than owner) x" FOR DEPARTMENT USE ONLY BUILDING PERMIT—ISSUED . ---- `--=--------==---- - � Q'''� DATE ��:�r ------. ,1 APPLICATION ACCEPTED+BY ___________________ -�-------_--__--=----�---_--�---�� - ._.._----DATE_--- `_- -_ --- -------------._-�.----- ---- AQQITIONAL COMMENTS - - - - ----- ---------------------------------------------------------------------- = -------------------------------------------------- ------------------------------------ ------- - ----------------------- - -- ------ ------ - ----------------------------------------------------------------------------------------------------- ------------------------------------ - - -- ---- ---- - ------ ----- i� ------ Finallnspection-by:--- Date — _ -- - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M