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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 7 Permit No. ----------------- ` ]� - `fGomplete in Triplicate) .. a»,.. �_ .� =-------------------- - ------ -- ,.. _ b � 1� - .. Date Issued - -7---.�-. This Permit Expires 1 Year From Date Issued Application is hereby :Wade 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 CounZOrdinanc No. 549 and existing Rules and Regulations. JOB ADDRESS/LOCATION . - -- Q CENSUS TRACT -------------- ----------- JOB Name --- phone{ = Address City ---------- ------------- Contractor's Name '� �1 /' License # � '�� !�• Phone Installation will serve: Residence 9 Apartment House[] Commercial:❑Trailer Court ❑ Motel ❑ Other -------------------------------------------- _ Number of living units:..*_ __ Number of bedrooms _ ------Garbage Grinder*-0-_ Lot Size _ °. ' n •' P Water Supply: Public System}and name Private ❑ Character of soil to a depth of�3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam4 :❑ ' Hardpan ❑ Adobe Fill Material ----------- If yes, type -------------------- t t t a � ' y(Plot plan, showing size of lot, location of system in relation to wells, buildings, .etc. must lie placed on rejerse side.) iNEW-INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet') ?, ■. i �X-- � 4 ' Liquid De th r PACKAGE TREATMENT [ ] SEPTIC TANK' If Size_ q P . � - Q ' Capa T e - Material l __It_�No. Compartment 's __ ------ -•-•-- " Foundation !�`!~---------- Prop. Line -11----------- to nearest: Well -------------------------- LEACHING LINE No. of Lines Length of each line...- - .01 a------------- Total Length sf.�- ----•---- is ante .2 = 'D' Box _1j/ - Type Filter Material � Q /D pth Filter Material ._".�' - ----------- ! --- -- ■ Distance to nearest: Well _____ '__---____ Foundations _____________ Property"Line .. SEEPAGE PIT {� Depth _ _�-_ Diameter _ear q---- Number _--�..q_.____-�- Rock Filled Yes No 0 Water Table:Depth -----4 to------------------------ -` -Rock Size __ ---- Distance to nearest: Well'..-----' -� __-Foundation .../a�"'_... Prop. Line . REPAIR/ADDITION(Prev. Sanitation Permit# --------.---------;---------------yY-------- Date -----------------------"'---------1 , r + 1..., w Septic Tank (Specify Requirements) ,----------- -----------`..-------------- ' Disposal Field (Specify Requirements) __-_..._.__ . ----------------------- I ....., ... t ----------------- --------------- -- -------------------------- ---------- ' ; ! ----------------- - ----------------------------------------------------- -------------------- ----- ----------------------------------- --- - - I 1 ;1 (Draw existing and required addition on reverse side) i I hereby certify that 1 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 { f "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to,become subject to Workman's Compensation laws of Cal iforn, ia." ) a Signed ------- --------------=-------- Owner { k ?.O� Title --------------------------- 4 B ---------------- '�'" ' Y {1f other t an ow " ri FOR .DEPARTMENT USE ONLY r � APPLICATION ACCEPTED BY ------ --------------------------------- DATE ..�`-��:'6-----------;--------- - - - ---- -------------------- -------------- BUILDING PERMIT ISSUED ---------!-- --- - DATE -------------------------------,••.--- - ----- I ADDITIONAL COMMENTS a----=�� Q �x "---------•------ --------------------------------------------------------------------•--I ----------------- ---------------------------------------------------------------- " ----------- --------- ■ -- -- ---- ------ :_ ------- 1 ;j,;-- �� - ------------ _b Final Inspectron . ----- � -- ------- ----------- ---- =.Date - -- - - - . SAN JOAQUI LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M �'