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FOR OFFICE USE: T APPLICATION FOR SANITATION PERMIT tVft (Complete in Triplicate) _ Permit No. -7,, •- --------------------------------------------- /J .............. This Permit Expires 1 Year From Date Issued Date Issued 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/LOCATION !----- ----- G-------------------- --------------------- - -----CENSUS TRACT ------f� -••---------- Owner's Name --- ----------Phone Address ---------------- -ZA ---- -- --------- City Contractor's Name - - e ------- ----------License #/e sib------ Phone 6_:/ _D Jr Installation will serve: ResidenceVApartment House,] Commercial :❑Trailer Court ;❑ Motel ❑ Other ------------ ---------------------' Nurriber of living units:.---- Number of bedrooms ___._..Garbage Grind Lot Size -_-.__ ------------------------------------ Water L x— - -----------------------•- Water Supply: Public System and name ____----.-___.._.-___. ----------------Private ❑ Character of soil to a depth of 3 feet: Sand ❑ 'Silt❑ ' Clay '❑ "Petit❑ Sandy Coa`rn ❑�'Clay Loam ]- I Hardpan ❑ Adobe-$ Fill Material ..--------I- If yes, type,-------------------------- (Plot plan, showing size of lot, +location of system in relation to wells, buildings, etc. m�`be.'placed on reverse side.) 9 NEWINSTALLATION: (No septi c tank or seepage pit permitted if public sewer-is available.with in 200 feet,) \ PACKAGE TREATMENT [ ] SEI IC TANK-L ] ' is Size----------- _ ------- Liquid Depth ------------------•----__- Capacity ----------I--------- Type -----'---------------- Material---V Noforom_/Prop, partments ------ ............... U Distance to nearest: Well ------------------------------------Foundation --_------ _-_ Line ------_--------------- i LEACHING LINE [ ] No. of Lines ------ Length of,�each`�line __ Tata! Length ,...-...-__ - - ----------------- 'D' Box - Type,Filter, Material --------------------Depih Filter-Material -------------------------------------- Distance -------;-.--------------------------Distance to nearest: Well ------------------------ Foundation -------------------- - Line .--_--_--------__....._- SEEPAGE PIT [ ] Depth -- --.,R _ ,__..Diameter_---------------- Number ----------—1-------------- Rock Filled Yes ❑ No C) Water Table Depth --------------------------- ------------ ---Rock Size -------------------•------ Distance to neaS! t: Well -------------------•--- � tt op. j f_______- _Foundation l...-_____--+____-- PrLine ................. REPAIR/ADDITION{Prev. Sanitation Permit# -------------------------------------------- Date------------------------------------ Septic Tank (Specify Requirements) - Disposal Field !Specify Requirements) ---------s .��---X.-�" �- -------- _--.-- ----1 T'----=-------- ---------------------- --------------------------- -------------------------- ^----- -------- ; •.w a - -- -- --- - -- ------ --------- ---- __ (Draw existing and required.a- di ion on reverse side)_ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Courcy 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 Compensation laws-of California." _, v _,..._ Signed - - --------------------------------------- Owner By - ----1 -' - (I -of an owner) - - --------- ------------------------- Title ---- -�- ------------------------ ---------------------wner) - DEPARTMENT USE ONLY APPLI12ATION ACCEPTED BY --- ----------------------------------- DATE f,= -= BUILDING PERMIT ISSUED -- ----- - -- -- - -- ---- - ---.---- ----------- - -D E ADDITIONAL COMME --- -------------------------- . ------------------------------------------- --------------- - �- .I_eh✓� �Jt� -------------- - -- -------- �� =" /i S s S r C _ - - ----------- ---- ------- --=- ----- -------------- ------------- Final Inspection by: - - ---------------Date JOAQUIN LOCAL HEALTH DISTRICT E. H. S' 1-'68 R v M