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FOR OFFICE USE ,,,i -. APPLICATION FOR SANITATION PERMIT ------------------------------ -- �✓-- (Complete in Triplicate) Permit No:7a_—_7__ ._ f _________________________ This Permit Expires ] 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 ADDRESSAOCATION Al/K------------- ----------------------CENSUS TRACT -------------------------- i Owner's Name ----------e5a .----•------------------------------------ ---------- Phone-------------- ---------------------- Address ------------------ fQ ----- Contractor's ---Contractor's Name ___ C ____.License # 11 _3_-- y_ Phone ___________________________ I Installation will serve: Resident A artrrient House Commercial: Trailer Court ;❑ Motel ❑ Other --------------------------------------- Number of living units:.-- ---- Number of bedrooms ________Garbage Grinder ---------!_. Lot Size _ -< - -______________ Water Supply: Public System and name _ Ell ----------- ---------------- ---------------- - ----------------------------------Private Character of soil to a depth of 3 feet: Sand'[:] ~ Silt[] Clay E] Peat❑ Sandy Loam ,� 'Clay Loam Hardpan ❑ , Adobe ❑ FillMaterial ------------- If yes,type ---------------------------- (Plot ____________-____________(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 withi.n 200 feet,) ' PACKAGE TREATMENT { ] SEPTIC TANK fLj- --I----------- Liquid Depth ___�_-_____-_ Capacity ________________ __ Type - --_-- Materidl-- - ------ No. Compartments -1;--- 40 Distance to neares Well ______So--____________________Foundation -----).0 Prop. Line ___S p,..:__....._ LEACHING LINE [ ] No. of Lines -------S-------------- Length of each line.....riQ__'-------------- Total Length .--_ .......... . 'D' Box ----- i ---- Type Filter Material ---�_1' _Depth Filter Material __1-V___________________________._...----- Distance to nearest: Well __________ ------ Foundation -------10--_r________ Property Line ____-47�_____________ SEEPAGE PIT [ ] Depth -------------------- Diameter ________________ Number ------------------ --------- Rock Filled Yes ,❑ No 0 Water Table Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ---------------------- ! REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date __________________________________) Septic Tank (Specify Requirements) -------------------- Field (Specify Requirements) ---------------- --------------------------- ------------------------------------------------- -------------------------------------------------------'----------------------------------------- ' (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 Wor 'man's Compensation•laws-of California." Signed ---------------- ---------- ------ -- ----- ....... Owner BYe__ ��-r ------ Title (If other than owner) i /FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --,.----------------------------------------------------------- DATE -- � � p Q BUILDINGPERMIT ISSUED ---------------------------------------------------------------------------------------------------------DATE -------------------- ADDITIONALCOMMENTS --------------------------------------------------------------------- ------------------------------------------------------------=--------------------------- ----- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- A --------------------------------- ------ ------- ------------------------------- ------------------------------------------------------------------- -- --- ------------------------- - - --- -- ------------------------------------------------------------------------------------------ --- -- ---- --- Final Inspection by: - -----�� -- ---- -- - -- --------------------------------------------------------------Date --- SAN JOAQUIN LOCAL HEALTH DISTRICT .!A E. H. 9 1-'68 Rev. 5M.