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FOR OFFICE USE: -- APPLICATION FOR SANITATION PERMIT --------------------------------------------- / (Complete in�plicate) Permit No. ._7—?-- ----------I------------- ------------------------ Date issued --- --------------------- --- --------------------------- This Permit Expires 1 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 Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION �------ --------- ---- - ------------- ------CENSUS TRACT .------------- ----•------ i Owner's Name 11 - ------- ------ Phone Address ' �5 1_ 1 !' l . City ----- /0G- -----7 ----------------------- ------ Contractor's Name - -�_;;_�__.License # __a.Z,5 4742-7 Phone ' - Installation will serve: ResidenceApartment House❑ Commercial'El Trailer Court ❑ Motel ❑Other -------------------------------------------- Number ------------- ---------------------------Number of living units:________ Number of/bedrooms -_2r___Garbage Grinder ------------ Lot Size _�u.S'-JCl . .-------- Water Supply: Public System and name -----[ ---------------------------------------------------------------------------------------- F] Character of soil to a depth of 3 feet: Sand❑ Sift❑ Clay Peat❑ Sandy Loam ❑ Clay Loam:❑ 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-----------------------------------•------------ Liquid Depth -----------------..--.----- [A (5!�r✓� Capacity -------------------- Type -------------------- Material---------------------- No. Compartments ------------•--------- r Distance to nearest: Well _____________________________------Foundation ----____ _____________ Prop. Line _________-. _,______ � r LEACHING LINT: [ ] No. of Lines ____Z_______------- Length of egch line__ / __ Total Lengthf.e �------------- 'D' BoxL.�__- Type Filter Material Ar ----Depth Filter Material ____-l"_________._____�...-..____.. Distance to nearest: Well __t+fr_txt/— Foundation __1_6--------------- Property Line. - -----___.__. _ a SEEPAGE PIT [ ] Depth ------ Diameter _,33-_____ Number ----------/_______________ Rock Filled Yes No Water Table Depth ----�-5-------------------------------------Rock Size r Distance to nearest: Well .____ - --__________________Foundation /-O-_________ Prop. Line --s_s .... REPAIR/ADDITION(Prev. Sanitation Permit# _...---------------------------------------- Date ----------------------------------� Septic Tank (Specify Requirements) -------------------------------------- ------------------------ --------- ------------------ ----------- i Disposal Field (Specify RePquirements) __ __ - -- 7t - - ----- ' ---- ---------------------- - ------- -- - - - ------------- ------ �� (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 becomet to Workman's„Compens tion laws of California." Signed ----- - - - -------- � �_� Owner �. ------ Title ----- -------------------------- (If other than own FO DEP T USE ONLY APPLICATION ACCEPTED B -------- ---- ----- -------------- -- ----!-/ 4 DATE --- BUILDINGPERMIT ISSUED --=----------------------------------------------------------- ---------------- --------------------------DATE --------------------------------- --------- ADDITIONAL COMMENTS ------------------------- ------------------------------------------------------- -------------------------------------------------------------------------- -- ------------------------------------------- - ----------------------------------------------------------------------------------------------------- ------------------------------------------------------ ------------------------------- ------- ------------- --------- ---- ---- -------------------------------- --------------------------- -------- - Final Inspection by: -- ------------------------------------------ ----Date _�_Z S=--�� 5A JOAQUIIv LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M