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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 1 ----------------------- ------ Permit No. -7� = 3,V7 fComplete,in Triplicate),,- --------------------------------------------------------- riplicate)`,---------------------------------------------------------- r ---_-_--. This Permit Expires i Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: ) j 1, CENSUS TRACT S__ ___,_ .---_--- JOB ADDRESS/LOCAT N ------I- I 4 r j Owner's Name = _ Phone -� _ i 110124411- (� -------------------------- City------------ /`, Contractor's Name License #� Phone 7UU__�'_ Installation will serve: Residence KApartrnent House-[] Commercial :❑Trailer Court ❑ F1 Motel ❑Other ------------------------------------------- Number -------------------------------- --- - - -Number of living units------I----- Number of bedrooms _____Garbage Grinder -------- 6 ,Size _____ _ ________ :_..-------- Water Supply: Public System and name --------------_-_--------------------------------------— - - Pri pte'� Character of soil to a depth of 3 feet: Sand❑ Silt Gay ❑ Peatr] Sandy Loar'n •❑ Clay Loam 0 F. p ❑ ----------- If yes, type Hard an Adobe Fill Materia -_ If e (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc: Zst be-placed--•on--reverse side.) \ NEW INSTALLATION: (No septic seepageepitper permitted. ifp public lssee- l '1i thin 2.00 feet]1Liquid Depth .PACKAGE TREATMENT SEPTIC TANK [ � Capacity -------------------- t Type =------r--------- Material---------------------- No. Compartments = f Distance to nearest:I Well ------- --'-------------------- --- on ! Prop. Line . Fouridati - ----Fil------Material - D h Filter r": Total Length LEACHING-LINE. [ J No. of Lines ___ Length of each lin _ terial 'D' Box ------------ Type ter p. , F Distance to nearest: Well -------- .----_------ Founda ion ---------- Property Line. ----------------- ...... PIT [ ] Depth ________________ Diameter ____--__ NumbLock;Size ____ ________-__________ --- Rock Filled Yes ❑ No �q Water TableDepth'`---------------------------------------•------ --------------------------- Distance to nearest: Well ---------------------•-----------------(Foundation ------------. ...... Prop. Line ----------------- r ( V1i REPAIR/ADDITION(Prev. Sanitation Permit# _______..___________________________________ Date ________._.:._._._ ..__,__:_.____ ) 1 Septic Tank (Specify Requireme ts] - -------- ; - — '� - �- f f/� f Disposal Field (Specify Requirements) ------ —moi '- 7'i1 `= ------------------------------- -----------------------------------------------=------------- = 3 'Of ------ ----- ------- -------_----------...._---•----------------- --------------------------------------------'---- ----------- =--------------------------------------------------- (Draw existing and required addition on reverse side) I hereby certify that .I have prepared this application and that the work will be done its 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: ttl<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 bec� 6--s ubject to Workman's Compensation laws of California." Signed --------- ---- --------- ------------------- Owner 9 ' Title ! BY ----------=---- --- ---------- ----------------- - ----------------------------- -F (I other n owner) —FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY el --- = -------------------------------------- -----------------•. DATE :----�---7 --- - -•------------------- BUILDING PERMIT ISSUED ------------------------ DATE ------------------------------------------- ADDITIONAL --------------------__---- -- - - ----------- ADDITIONAL COMMENTS ____________________ -- i = ------------------------------------------------------------- --- ------------ ----=------- ------------------------------- - - ---- --- ------------------------------- ------ - Final Inspection by: - ___---------- - ---•----- -------=------------ - - --•--------------------- ------------Date -- -- -- -- ----- -- ------ j ----------;------•-----------------'-----------------------------------`--------------------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT �- E. H. 9 1-'68 Rev. 5M i