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FOR OFFICE USE: A _ICATION FOR SANITATION PERMIT (Complete in Triplicates Permit No. 7 ' --____. --------------------------------------------------------- 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 ._-Q? P�. !j ,J --��ie/��--- - --��'.--- ��-----------CENSUS TRACT i------------------------ Owner's Name _ ff /jlQ�a�1__ rt✓T---------------------- -----------------Phone ------------------------------------ Address c � ---- ----------------- Cit) ----------------------•-•-•------ Contractor's Name __. s � _---------------License # Phone Installation will serve: Residence ❑Apartment House,❑ Commercial []Trailer Court -7 Motel E] Other Number of living units:.__!.------ Number of bedrooms -Garbage Grinder ------------ Lot Size _• - -C __c• Water Supply: Public System and name --------------------------------- Private Character of soil to a depth of 3 feet: Sand.'El � ,Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe Fill Material ------------ If yes,type --____________-__-______-- (Plot plan, showing size of 10MI-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,) 1 PACKAGE TRE4TMENT [ ] SEPTIC TANK [ ] Size------------------------------------------------ Liquid Depth -------------------- W r5r'-ocr Capacity--------------------- Type -------------------- Material-------------- ------- No. Compartments Distance to nearest: Well--------------------------------------Foundation ---------------------- Prop. Line ---------------------- c G: LEACHINLINE [ ] No. of-Lines ------------------------- Length of each line---------------------------- Total Length ----------- ---------------- '6 L 'D'.Box -__ __;____ Type Filter Material --------------------Depth Filter Material ------------------------------._••-------.-_._ Distance to nearest: Well ___'___________________ Foundation ------------------------ Property Line __________--___--_._.___ SEEPAGE PIT �[ ] Depth — - Diameter �r Number -------f______--_______ Rock Filled Yes No — t" � f �xaI,/W f Water Table Depth ------_�J---------------------------------Rock Size _��_�_/-�---- � Distance to nearest: Well -----10c9-----------------------Foundation /47----------- Prop. Line REPAIR/ADDITION(Prev. Sanitation Permit# --------_------------------------_---------- Date __--_-----____________-______-___s ` Septic Tank (Specify Requirements) ---------------------------- --------------------------------------------------- al Field (Specify Requirements) _-- -------••--.--- ------- --- ` - -- - - -- --- ---------------------------------------- - ---------------------------------------- (Draw exists a required ad ition 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 sation laws Sigto ned ned become to Work Com� s of California.": Owner ----------- By --------- (if other Title -----------------I--------------------------------- of er than own r) OR DEPARTMEK USE ONLY APPLICATION ACCEPTED 8 ------------- _` `f__ DATE � ....I �L BUILDING PERMIT ISSUED ____________ ----------------- ----------�----- - -----��- _ - ------------------ -------- DATE -- --------- ------------------------------ - ----------------------- ADDITIONAL COMMENTS --------------------------------------------------- - -- ------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------ -- ------ ------ ---- ..r_____ _ ___________ __________________________________________________________________ _ _ _ ________________ _ .____-__ Final Inspection by: - --_------Date „ -' ., _- _ N JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M