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,.-_...1. _= 1_� FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 7 Permit No: -------- ------------------------------------------------------------------------------- (Complete in Triplicate) -------- ----- --------------------------------------- A- -�3dJ�-- _ 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: yam�y,, c.1 ✓l - CENSUS TRACT ------ ----------- JOB ADDRESS/LOCA71 N .-I. - ---- - Owner's Name -.-- -- --- - ---------- -------- - - - --�--------------- -----Phone ------------------------------------ Owner's -- ------------------------• - ._: ---------------------- Address -t - -- --- - -- - -�� --- - City ---- ------ �---------- ------------- ' License # � - - " Phone Contractor's Name -.---- � " Installation will serve: Residence [Apartment House❑ Commercial ❑Trailer Court `❑ Motel ❑ Other -------------------------------------------- Number of living units:----1----- Number of bedrooms ---3-----Garbage Grinder ----------- Lot Size - Private Water Supply: Public System and name -------- --------------------------•--------- Character of soil to a depth of 3 feet: Sawd❑ Silt❑ Clay ❑ Peat F1 Sandy Loam ❑ Clay Loam '[] Hardpan Adobe.E] Fill Material ------------ 1f yes,type ---------------------- ' (Plot plan, showing size of loft 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,) .� [ 4 ------- Liquid Depth --y--------------- S PACKAGE TREATMENT [ ] SEPTIC TAMC Size- ��---- �� x--�� q p i Capacity �^�4 � Type- /�!+- , Material-- o. Compartments - ----- Distance to near st: Well ----------- -.--------Foundation --------- Prop. Line .-----��_------•- No. of Lines -------3------------ Length of each line-------- =---- ----------- Total Length ---�•--- LEACHING LINE [ H D' Box -_--_ -. -- Type Filter Material --.:,_ ---Depth Filter,Material -------- s i `®_--- ------ Property Line ...... .-----•-------- Distance to nearest: Well ---_---D--_-_-!e Foundation -- - --:- -- Number ---_ -- --------- Rock Filled Yes No-�{ k .SEEPAGE PIT [ ] Depth ---- Jr-------- Diameter ---------- - �� rr -�—�— l> Rock Size ----/- Water Table Depth -------------- -- - ---�-�--------- Prop. Line ------""�•-------•-- Distance-to nearest: Well -----------J-� ------------ -----Foundation I REPAIR/ADDITION{Prev. Sanitation Permit# -------- ----------------------------------- Date ----------------------------------1 Septic Tank (Specify Requirements) ------------------------------------------------------------------------------------------------------------- - 41 1 --------------- T Disposal Field (Specify Requirements) ---------------------------------------------------------- ---------------------- --------------------- (Draw existing and required addition on reverse si d e I hereby certify that I have prepared this application and that the work will be done Iaccordance with San Joaquin t County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or Hcen- f sed agents signature certifies the following: f permit is issued, 1 shall not employ any person in such mann "I certify that in the performance of the work for which this er as to become subject to Workman's Comp sation laws of C 14fornia." Signed --------------------------- ----------- -- -- --- Owner ---`- -. �� • 'tie ----- --- ------------------------------------------------------------ By ---------- --------- -------------- ----- --------- -------- -------- -- -------------------- - ------------------ - (if other than owner) FOR DEPARTMENT USE ONLY D�AE - -�- 7 - ------------ APPLICATION ACCEPTED BY BUILDING PERMIT ISSUED --------------- - --------------------------- DATE - ADDITIONAL COMMENTS --------------------------- ------------------------- --------- ---- ----- -------------------------------------------- ------------------------------------------------- ---------------------- ------------------- --------------------------- - -------------------------------------------------- /------------------- - � .Date - . ---------- Final Inspection b ------------ - SAN JOAQUIN LOCAL HEALTH DISTRICT F u 0 1-'68 Rev. 5M