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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -------------------- ----------- Permit No. 7-�- -�- (Complete in Triplicate) Date Issued -Iv _- -----------------------_------- This Permit Expires 1 Year From Date Issued ---Z- ---7. 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 ------------ -:---- -------- ------------- --- ------------ ---- ---- ---- -- - CENSUS TRACT ----------`•'-- ------_ -----••------------------ ----- -Owner's Name - ---- -------------- Phone 1-�-- Address ----7 G _�tPi-— -------------------------------- City T Contractor's Name ----------ef t -- --.-�--.License # .�•S-�17�__ Phone -/_______------ •....... Installation will serve: idence /Apartment House Commerc Resial frailer Court ❑ Jam' Motel ❑Other ------------------------------------------- Number of living units:__-_, Number of bedrooms ----------Garbage Grinder ------------ Lot Size .1.W-- ---------- t Water Supply: Public System and name -------------------------------------------------- --------------------------------------------------------- Private ` t Character of soiltoa depth of 3 feet: Sand'[] Silt❑ Clay FMXPeat❑ Sandy Loam ❑ Clay Loa f I Hardpan ❑ Adobe ❑ Fill Material ------------ If yes, type ---------------------------- (Plot plan, showing size of tot, location of system in relation to wells, buildings, etc, must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,] PACKAGE TREATMENT ,pC SEPTICT TANK:[ ] ize �_/ _/ ---------------- Liquid Depth ---_--.------------_ ' Ca acit ' yp Materials-___.__ No. Compartments 1 Q T Distance to nearest: Well ___ ________________________Foundation _, ______----__ Prop. Line __ta ._�____._ LEACHING LINE No. of Lines -----/-------------- Length of ea & line_/W_0...-........ Total LengthC2_______- / 'D' Box -f �---- Type Filter Material_ _. _03-4&pth Filter Material --- ---------------------_------_�•_--__._ 1 Distance 'to nearest: Well _-�-_________ Foundation _ _____________ Property Line _a-:`---___-.------- SEEPAGE PIT [ }.' Depth r_.�_-_--_-'__ 4__ Diameter ________________ Number ---------------------------- Rock Filled Yes [:jNo ❑ Water Table Depth ------------------------------•--- Rock Size -------------------------------- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ---------------------- r I REPAIR/ADDITION(Prev. Sanitation Permit# ------------------------------ ----------- Date ---------------- ----- ---________-_-_ ) Septic Tank (Specify Requirements) -- r� 'll��` � '! Disposal Field (specify Requirements) ' ----- s �: �---�----- E --- --------------------- --------------- ---- ----------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------- i 1 (Draw existing and required addition on reverse side) t I hereby certify that I have prep red this application and that the work will be done in accordance with San Joaquin i 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 bete s bject to or uA's Co� claws of California. ' Signed --- -------- -- --------------- -- Owner BY ---- - - ---------------------------------------- Title ---------------------------------- ------------------------------------- (If oth r thanwin - FOR .DEPARTMENT USE ONLY b .� - _ DATE -_�-D--2-�- /--------- APPLICATION ACCEPTED BY .:1/!/ ------------------ BUILDING PERMIT ISSUED ----- ----------------- - -------------- --==--------------------------------------------------------` , ' DATE - ---------- I----------------------------- ADDITIONALCOMMENTS ----------------------------------- ---------------------------------------------------------------------------- i ------------------------------ ------ `------------------ Final Inspection by:' ` --------------------------------------- Date _� SAN JOAQU LOCAL HEALTH DISTRICT . k E. H. 9 1-'68 Rev. 5M