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FOR OFFICE USE: r APPLICATION FOR SANITATION PERMIT - ------------- - --------------------- -------------- Permit No. _7/--6 �f = ._ (Complete in Triplicate} --------- ---------------= - . -. s� Date Issued _._I��_?�_ -I __________________________________----_---------- This Permit Expires ] Year From 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 O--rdinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION __�____�±_-- --- -- ------ '-�-CE -------------------------- --CENSUS TRACT Owner's Name -_____- `L 414---------------------- ---_ Phone��2rT�: ----- G Address ------------- -= ✓ �_ - -/ r------- ----.__. City -- ---------------k----------------------------...... Contractor's Name _-______ __ � �sr¢ P_�A�_License ______ Phone ��_--_.Z6E �___ Installation will serve: Residence?&Apartment House❑ Commercial :❑Trailer Court �i❑ Motel ❑Other -------------------------------------------- • Number of living units:___ ______ Number of bedrooms ___5-----Garbage Grinder _:___ ___ Lot Size -- -- rye -� - - ---------------•--- Water Supply: Public System and name ------------------------------------------- ------------------------ ------- Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt Clay ❑ Peat ❑ Sandy.Loam ,�< Clay Loam .E] Hardpan ❑ Adobe ❑ FIII Material . --------- If yes, type __________________________ f (Plot.plan, showing size of lot, location of system in relation to.wells, buildings, etc, must be placed on reverse side.) NEW INSTALLATION: a `'t {No septictankor seepage pit`permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT ['] SEPTIC TANK'[ ] Size-------------------------------------- --------- Liquid Depth ---------------------,----- E Ca acit - � p Y .�- -------------- Type --------------- - Material------------------------ No. Compartments ..................... 11%\ Distance to nearest: Well ____________________________________Foundation ---------------------- Prop. Line _____________:________ LEACHING LINE [ ] No. of Liries' _---------------_-------- Length of each line---------------------------- Total Length -----------._____________.__ 'b' Box ------------ Type Filter Material ____________________Depth Filter Material _-____-________________-_____-______________ Distance to-nearest: Well ______________________ Foundation ________ Property Line _____________________ SEEPAGE PIT [ j Depth -------------------- _____________ Number -______�_________________ Rock Filled Yes E] No C)Water Table Depth ______'� Diameter . p `� --------------------------------Rock Size - =-------------------------- Distance to nearest: Well _______-_`_______ _ _ __________________Foundation -------------------- Prop. Line ...................... REPAIR/ADDITION{Prev. Sanitation Permit# ____________________________________________ Date -----------------------------------) Septic Tank (Specify Requirements) --------------------------------------------- --- -,-------- -------------- Disposal Field (Specify Requirements) ----------------��N----------,--d---------� --- ------------------- A---------- -------------------------------------------------------------------------------------------------------------------------- ---------------------------------------=------------------------ 4 (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 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 California." Signed ----------------------- ------- Owner By -- ----------- ---ld[---=------- ----- --------------------------- ------ Title ---------------- -------------------- ---------------------------- -------- ----------- (If othe t an owner) FO DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------ BUILDING PERMIT ISSUED________-C��___ ?/ ------------------ _ _ -------- ---- DA ._ �1. ------- _ � -ADDITIONAL COMMENTS e -------------------------------------------------------------------------- -------------------------------- r ------ ------------------------------------------------------ -- ------------------------------------ C '_.=C � __ Final Inspection by- - ---------------------------- ® -----•------------------------- -------------Date -------'�`�=7-------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M