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�- F R OFFICE USE: APPLICATION FOR SANITATION PERMIT ----------- ------- � .S �•.� Complete in Triplicate) Permit No.7 `-_____.--_--. ---------=---------------------------------------------- This Permit Expires 1 Year From Date Issued Date Issued lP_'. Application is hereby made to the San Joaquin Loco 1''Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 349 and existing Rules and Regulations: JOB DDRESS/LOCATIO f p 6 CENSUS TRACT 17---- ---------- "' r Owner's Name z::. . .. -----------Phone '. ---------- --- - -------- --------------------------------------------- - L -7_ -- - - City _ ---- --------- ----- ----------------------------- -------- ------------------------ ------- - w. Contractor's Name Ste---- `-�----------`-----------License # - Phone t7 �� rr6D� Installation will serve: Residence ❑Apartment Housef! Commercial ❑Trailer Court i❑ Motel ❑Other ----------------- Number of living units:--_. Number of bedrooms _:Z ._Garbage Gri ern � Lot Size --- Q x O L.l Water Supply: Public System and Warne --------------------------- _------------------ Private ' to ❑ Character of soil to a depth of 3 feet San-d'❑ Silt "Clay 0,—Peat❑- .,Sandy, Loam E] Clay Loam ❑ Hardpan ❑ Adobe'[C Fill Material ------------ If yes, type ---------------------------- (plot ________.___________ -(Plot plan, showing size-of lot, location -of system in relation .to wells,.buildir 6.s,;etc. must-be�placed on reverse side.) k NEW INSTALLATION: (No septic.tank or seepage pit permitted if public,sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK [ . . Size-------------"`=-:----- +-w------------------ Liquid Depth ---------------------_. N Capacity_-_,'------------- -Type -------------------- Material___ t_.___:- 'No. Com 'artments Distance to nearest: Well- ------------------------------------Foundation.----I----------------- Prop. Line ---------- ------ LEACHING LINE [ J No, of Lines ------------------------ Length of each line-------_---- _____ Total Length 'D' Box ----------- Type Filter Material _ _______ - - -----Depth Filter Material ------'---------------------------------- Distance to nearest: We11`'1 _` -----_--- Foundation ___________________ ___Property Line. ._________-_ SEEPAGE PIT [. ] Depth ___________________ Diameter ---------------- Numbe: - Rock Filled Yes E] No i❑ s Water Table Depth ------------------------------------------------Rock Size --------------------------------- Distance ----------------- -------------Distance to nearest: Well ----------------------------------------Foundation ---- --------------- Prop. Line ---•------------ REPAIR/ADDITION(Prev. Sanitation Permit# --------_----------------------------------- Date ______._-__ Septic Tank (specify Requirements) ___ Disposal Field (Specify Requirements)• ___.--_____ ,.. t ------- ----------- - - ----- ------ - -------------- `r '--"may ________________ ---_______ ____- 7C_ -------------- t ..,, ---------------- - ti. ----------------=----------------------"------ y,----------------------------------------------- (Draw existing and required addition on reverse side)` I hereby certify. that IC. 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'pe'rmit,is issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws oka—liforn'. . ,-- ; Signed ------r--------------------- --- ------- ---- Owner ------- -- ----------- -- By----------- ----- --------------------- --A------ - Title --------- - (If other tha ner) R MENT USE ONLY APPLICATION ACCEPTED BY .__ DATE ----- -1 " -- BUILDING PERMIT ISSUED ------------ ---------DATE ---------------------------------------- ADDITIONAL COMMENTS _________ _ ___ ---------------------- ----- .........- 4-- ------ ---------------- ----------- --------------- -------- 1A -- -- ----- -- ----------------------- - ----------- ---- - ---- ---- - - -------------------- ------------------------------------------------------------ ------------ Final Inspection by: ____ - ----- - - -� ------------------------------------------ -------------------------------- ---- -------- -------------D--ate . ---�- ----- 7�----------------- JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M