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FOR OAF C USE: APPLICATION FOR-SANITATION PERMIT )y ' (Complete in Triplicate) Permit No __7�-5 -------------------- ___.__._. ------ - --- Date Issued ---------- -- 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 is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATT-ION . _ / i , '� � i------•------------------CENSUS TRACT --------------_ ........ Owner's Name --1t -��1- -------------------------------------------------------- -----Phone ---•- Address -'--1`�_aI 7-_'----------------------z--------------------------------------------------- Cit /fes ------------------------- Contractor's Name --- eve r.0 ---------------------------License #IA6��ffl!ZfA__ Phone Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court l❑ f Motel ❑ Other -------------------------------------------- . f Number of living units:---/--__ Number of bedrooms rX------Garbage Grinder �'�" Lot SIZE __��.�-�.�+�°.............. Water Supply: Public System and name _ 1 �7� �1___ ___________________________________________________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 ____________________________ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) S NEW INSTALLATION- (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ j SEPTIC TANK'[ j ., Size------------------------- ---------------------- Liquid Depth ________.___-------_______ Capacity -------------------- Type --- .------------ Material--------- -------A-- No. Compartments ------ -------- ...... Distance to nearest: Well ------------------------------------Foundation ------------------- Prop. Line -------------:........ LEACHING LINE [ j No. of Lines ________________________ Length of each line---------------------------- Total Length ---__.____-__________--__-- 'D' Box ------------ Type Filter Material ____________________Depth Filter Material-___ ----------------------........__..____-_ Distance to nearest: Well ________________________ Foundation -- Property Line _________.______-------- SEEPAGE PIT [ ] Depth --------- ------- -------------- ❑ 0 c Diameter Number ____________________________ Rock Filled Yes No Water Table Depth ------------------------------------------------Rock Size ___________________ Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ----------------...... REPAIR/ADDITION(Prev. Sanitation Permit# ____________________________________________ Date ----------------------------------) SepticTank (Specify Requirements) ---------------- ---------------------------------------------------------- -------------------. --------------------------- ecify Requirements}Disposal Field (Sp r -12 -1-------------------------------------------------------------------------------------------- II (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 Compen ation laws of California." Signed ------------------ - -- -------- ------ ----- ----------------------------------- Owner BY - - ----------------------------- Title 'c- --------------------- (If er than own r) FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTEDBY ---------------------. DATE ��- `_/----------- BUILDING PERMIT ISSUED --------- -------DATE ---- ------------ --------------- -------- ADDITIONALCOMMENTS ---------------------------------------------------------------------------s------------------------------------------------------=--- ---- ---------------- ------------------------------------ ----------------------------------------------------------------------------------------------------------------------------------------------------- -- ----------- ------------------------------------------------------ - - - --- -------- ------------------------------------------------------------------------- - -------- --- -- -------- ---------------- Final Inspection --- ---•- -- ------ f-. SAN JOAQU LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M "