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FOR OFFICE USE: 0APPLICATION FOR SANITATION PERMIT } Permit No."7- ----�--Z. ----------- - (Complete in Triplicate) ------------ -------------- - ----------------------- Date Issued -__-f-.--_--w" ----------- i This Permit Expires 1 Year From Date Issued --------- Application is hereby made to the n Joaquin Local Health District for a per to construct and install the work herein described. Thi's application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ------ _77/T- --- -- ----------------------CENSUS TRACT -------- ----------------- _*1 �} ,, j , Owner's Nome"-----------4r-' 'L"p"'" --------------------------------- --- Phone ��---Q Address ------- -------1-6 r City a Contractor's Name --- ------1---- r W-----4' '-�- ---------------License # t'l - � ------ Phone _Y Installation will serve: '-""`"" —Resi&h–ce`�-Ap'artment•House.❑-Commercial :OTrailer Court–],El- Motel ❑ Other -------------------------------------------- I Number of living units:---- Number of bedrooms„_--_ _Garbage Grinder of Size �Q ,k�_� - 1 _-Private ❑ ' Water Supply: Public System and nam1. e ------------------------------------ "` Character of soil to a depth of 3 feet:' Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe-7 Fill Material ------------ if yes,type ---------------------------- (Plot plan, showing size cf lot, location of system in relation' to” wells, buildings, etc. must be placed on reverse side.) e f '<, NEW INSTALLATION:, (No septic tank or seepage pit permitted if`public sewer is available within 200 feet,) V PACKAGE TREATMENT [ SEPTIC TANK [ Size------------.`-=-------------------- Liquid Depth _______-------------..----- Ca acit T e ----- Material----------------- No. Compartments ------------••-•------ p Y -------------- Yp nearest: Well Foundation ----------------------Prop. Line ;------ - No. of Line } i" 1 j , ------- Distance to -------------` Length of each-linea_--------------------- --- Total Length - M1 LEACHING LINE [ ] -g- --------- 'D' Box __:_- :___ Type Filter Material -_-----------------Depth Filter Material --------------------------- ------ Distance to nearest: Well- ------------------------ Foundation ------------------------ Property Line. -----------------= Rock Filled Yes No i0 SEEPAGE PIT [ ] _Depth v- -- Diameter --------•------- Number - ❑ ` Rock Size --------------------------------- iWater Table]Depth -------- ---------------------------------------- Distance to nearest: Well -------------------------'-----------•- Foundation ----- - "=" Prop. Line ---------------------- REPAIR/ADDITION(Prev. Sanitation Permit# ---------------------------------- ------- Date -- --------- ------------- j Septic Tank (Specify Requirements) ----------------- ---------------- ---------------------- ------------ - ------------ ------ ` Disposal Field (Specify Requirements) �1 ------------------ ------------------------------ --------------------- 4F -------------------------------------------- -------- _.-:- - (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 "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." Owner Signed ---- ------------------------ ------------ -- - --------------- ' Title ------ ------------ -------------- ------------------ BY ----- -- --- -- --- --- ------ - r-- --- - - her an owner) f FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY C_:---1--.------ - --- --------------------R 4 DATE BUILDING PERMIT ISSUED ------------------------- ---------,--- - DATE -._ -------- ----- ----------- ADDITIONAL COMMENTS -------�^ ------------------ - - ----- -------- e7 ---- - �j��'"`"------ ----- - ---------------------- -- ---------------------------------------------------------- ---------------- -------------------------=-------------------------------- --------------------------------- -------- ------------ ----- ---- ----------------•- -- -- ------------------------------------------------------------------=--------- --------- f Final Inspection b --- ------------ Date ,f�7�------- - --- ----- -- p Y N JOAQUIN LOCALr IHEALTH DISTRICT E. H. 9 1-'68 Rev. 5M