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- FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No.7L.- -_ _-."_ --------------------------------------------------------- This Permit Expires 1 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 I described. This application-is made in compliance with ou ty O,r inance No. 549 and existing Rules and Regulations: s, ` t-�J ( q C,'-- 4930- o y } JOB ADDRESS/LOCATION .-.-.l - �4f.1-- -_ �v------------/rZ-----------------CENSUS TRACT ---------------.-----..... Owner's NamePhone �� -.1e 11 p .yam Address -O __2at--.7. - --------------------- City ��/r;/ � tartl Contractor's Name -( '" " C --______.License # __ �1 _ Phone ___ _ ___C� _ e Installation will serve: Residence ❑ Apartment House❑ Commercial k,railer Court i❑ I Motel ❑Other �Ps Petr - Number of living units:---- ----- Number of bedrooms A/AxA_Garbage Grinder __-____-- Lot Size __ "`�_lC.. A-c�--`------ Water Supply: Public System and k name -------------- ------------------------------- --- ------------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand Silt❑ Clay .❑ Peat E]- Sandy Loam ❑- . Clay Loam :❑ !�� Hardpan \❑ Adobe.0 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,) i PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] f Size-----.-�_NLX------/Q------------------- Liquid Depth ----.--._.___,_____ ` ,fes Capacity ---eO ------- Type ----------------- Material-=-- 'Ca�� --- No. Compartments -------- ------------ ,. Distance to nearest: Well --_,---5�--f Q ________________Foundation ---/ --r________ Prop. Line ____,.�_- ........ -',3 .4 LEACHING LINE [ ] No. of Lines;�:__ _ _:_________ Length of each line---____ -rr.--.___ Total Length _ __ Q_____________ '1" �" i I ^rl fa Ir f/' f F 'D' Box -�Bsr1.. Type-Filter Material ___/V-__________--Depth Filter Material _____,� ______________________________ I r f I a•,JJgy Distance to neare�t: Wel! _ ,__"__-____ _" Foundation ___! _______________ Property Line _- ._..___.__._. T.f a 16 SEEPAGE PIT [ ] . Depth _____y�___-__ _ _ Diameter f ______________ Number ---------------------------- Rock Filled Yes ❑ No i❑ t!7t _*f Water Table Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line .................... � �. REPAIR/ADDITION(Prev. Sanitation'Permit# -------------------------------------------- Date _.--------------------------------I SepticTank (Specify Requirements) ---------------------------------------------------------------------------------------------:----------------••------ --------------------- Disposal Field (Specify Requirements) ----------- ---------•--------------------------------------------------------------------------------------------- ------ r --------- --------------- ------------------- ------------------------- i -------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------- t.�. -----A '(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, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ------------------------------------- ------ --------------------------------------------------.- Owner . BY ------------------=-- --------------------------------------------------------------------------------- Title -----------'----- ----------------------------------------------------- (if other than owner) t F REPARTMENT ONLY APPLICATION ACCEPTED B - -------4WX -------- --f- - -r=-------1------------------ DATE BUILDING PERMIT ISSUED .----- ------- ----------------------------- -------------- DATE .- ------------------------------ --- ADDITIONAL COMMENTS ---------- - --------- ---------- ------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------- --_--------------------------------------------- ------------------- ----------------------------------------------------------------------------- ----------------------- ------------------ ------------------------- ---------------------------- f --- - - Final Inspection by: -------- -------------------------------------•---------------------------- ------Date _ , 1 SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M