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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT . - - erNo.-.-7v_..- = .... (Complete in`Triplicate) P mit _ 5 Il------ ---------- - ---------------------- This Permit Expires 1 Year From Date Issued Date Issued _.��_�.. -- r------------------ --------------------- 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: , t JOB ADDRESS/LOCATION _J_J'_/_; 3-:------ -94?At-A-4,,(L /E----------R_,0 .. ----CENSUS TRACT -------------------------- Owner's Name -A412------ � f< ------------------------------------------------ -40- _/ ---------------=----------- ---- _ __� = -.___Phone Address az4e��---------- City --------------------------- -------------- Contractor's Name ---//<42�-----c-_d r7,& # /-7-7:'71r_7----- Phone _ 5 ---- Installation will serve: Residence WApartment House❑ Commercial :❑Trailer Court ❑ i Motel ❑Other -------------------------------------------- Number --------- ------------- -;:--------------Number of living,units:.-_/__-__ Number of bedrooms __•-_____Garbage Grinder W4!--- Lot Size _- 1 / - ----------------- -- Water Supply: Public System and name -------------------------------- -----------------s"-----------------------------------------------:' Private Z Character of soil to a depth of 3 feet: Sand[] Silt[] 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 I ] SEPTIC TANK, size- Liquid Depth -4/--------------------- Capacity �--�---------------------- pa �oZVleW �Material No. -1� Q --- Prop. --- Distance nearest: WeFound v I tion LEACHING LINE No. of Lines .3-------------------- Length of each line-----%f-�______ ------ Total Length 'D' Boxes-__ Type Filter Material �AC�_ �___Depth Filter Material -� __________________________________ l Distance to nearest: Well __ -_______ Foundation :_/p__r______________ Property Line ,.f---------......... SEEPAGE PIT [ ] Depth ---- --------------- Diameter ---------------- Number --°--------------;------ ❑ - Rock Filled Yes No .i❑ ; WaterTable Depth --------------------------------------I----------Rock Size .-------------------------------- Distance to nearest: Well ----------------------------------------Foundation -r----------------- Prop. Line ................ REPAIR/ADDIT1ON Prev. Sanitation Permit# -------------------------------------------- Date ---------------=------------------_1 Septic Tank (Specify Requirements) -------------------- ------------------ ------j-------------------------------------------------------------.---------=------------------ DisposalField (Specify Requirements) -------------------------------•--------------------------`----------------------------------------------------------- ----------- ------------- --------------l--------------------------------------------------------------------------------------=---- ------------------------------------------------------ -------------------- _ __ . _ .________________________-___-.___________..__________-__.______________________-_-_____________-___________-_____ ____________________________ __ --------------------------------- ------------------ R i (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 -Son-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 Workman's Compensation laws of California." ° Signed ----------------------------- ----- . Owner ---------- ----------- --------- Title __ - (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - --------------------------------- -------- DATE ------ ,� ------------------ - --- BUILDING PERMIT ISSUED --------------------------------- ------------- DATE = ADDITIONALCOMMENTS ----------- ---------------- --------------------------------------------- -------------------------------------------- ---------------------------------- ----------- ---------------------------------=------------------------------------------------------- ------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------- Final Inspection by- - --------------------------------------------------------------------------- 4TI, -- Date o -1 ---- --- SAN JOAQUIN LOCAL HEALTH DIS C. r E. H. 9 1-'68 Rev. 5M