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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. -7 ` -.,r,10. (Complete in Triplicate) f ................................................. Date issued .... ....••.. This Permit Expires ] Year From Date Issued -49 1 Application is hereby made to the San Joaquin local Health District for a permit to construct and install the work herein I described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: zd . . .....r/�"/ 5 , . JOB ADDRESS/LOCATION .... ....... :..:... . _..:... _-....__ ... . .. YCENSUS TRACT ......... Owner's Name ... 1�r... ........ P one 4 ' � "". Address . . ...... . City!/ `• Contractor's Name .....- ... . �.............................License # .........:.............. Phone __.... ............ Installation will serve: Residence portment House 0 Commercial :❑Trailer Court 0 � Motel ❑Other ............. •--•-------- -•••-•- . t Number of living units------ Number of bedrooms _.. Garbage Grinder ..__...._. Cot Size •Q -••----- •••• Water Supply: Public System and name . ................ ---------••-•-------------------- -•••-•••••------••I......Private4v , Character of soil to a depth of 3 feet: Sand❑ Silt❑ Cloy C3Peat tEl Sandy Loam ❑ Clay Loam TL _ Hardpan Adobe ❑ Fill Material ............ If yes,type ---------------------------- (Plot plan, showing size of lot, 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 [ ] SEPTIC TANK] Size .. .Xrt..-'7••---••--•-•••••.. Liquid Depth .... ! :�.b•_•••••-- �^/) Capacity lgap-- - TYp - Material..i'i/'t-•--....... No. Compartments .e' ............... �/ Distance to nearest- Well ...ar'. ._....•..............•-Foundation . -----......: Prop. Line ..t4�............._.... I s LEACHING LINE No. of Lines .. .................. Length of each line._.. -------........: Total Length .� '- .......__---_. 'D' Box .7-4A-0--- Type Filter Material {6-411e.........Depth Filter .Material ----- ............................ Distance to nearest: Well =�•••..•...•.-•-- Foundation &..- __--•_ Property Line .. ................•-_.. r, - - SEEPAGE PIT } Depth ------ Diameter ! ....... Number .... ................. .. Rock Filled YesZ No ❑ ..._.__----Rock Size -L- ...... Water Table Depth DC7------•-•----•••-----•-• Distance to nearest: Well .............. ..__Foundation ..J A�_......-- Prop. Line v ..:..____........ /" , k REPAIR/ADDITION(Prev. Sanitation Permit# ............... Date __........-- ..................... k Septic Tank (Specify Requirements) ................. ............................................................. ...............-•-................................ Disposal' Field (Specify Requirements) --------- ------------- ............. ....................................... ................................... I ----------------•._.....------ .....-•-•-•----... ...... ....... -----••----------- -•-----..... ............ _ ..... IDrow existing and required addition on reverse side) 1 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 Son Joaquin Local: Health District. Home owner or lken- 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 becom ubject to Workman' ompensation laws of California." Signedlk- / ----- Owner -•---•_.. Xitle ..................... ............................................ (if other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .. ...... ... .. DATE . __._..__.....-----.... -•..................... BUILDING PERMIT ISSUED . _-.._ ..............:DATE _-....: ADDITIONAL COMMENTS ..... J_... .7 ...•......-----••-----•-- :::o, •-------------•---. ------------------------......... ....... ...... 7 ................................... -- ----------- ......................................................................................................._._......._...:. ^.........._.._._._.._..... ....... Final Inspection b � ............................................................... ---Date `.1 ../?r � _. - ----•••-•• .--=......... ................•......._ ...... . SAN JOAQUIN LOCAL HEALTH DISTRICT 7/72 3 _