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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. .7-�"J-�� ------------- ------------------ -- --- (Complete in Triplicate) -------------- Date Issued S�=d.7_ 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/LOCAN [.t ------------- ------------ ----------------------CENSUS TRACT --(-O---`------------�J--- ----- --• -------------------Phone Owner's Name - ----- ------- ------- ------- --- --- ------ -----. City/` Contractor's Name - ------ 4 -� `� .-��---.License # - Phone Installation will serve: Residence, Apartment House❑ Commercial :❑Trailer Court i❑ Motel ❑Other ------------------------------------------ Number of living units:----I------- Number of bedrooms _2--_ ___Garbage Grinder ------------ Lot Size o - -.`- • Water Supply: Public System and name ------------------- - ---------------------------------------------------Private ❑ 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 publ' sewer ' vailable within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK ize___�-- .------------ Liquid Depth --- ------------_-- 4 �__ Material_- No. Compartments Ze_..________ Capacity r_�/------ TYpe r � � Distance to nearest: Well -- - Foundation --- - ------------- Prop. Line -------. _....-____. FF � 00 � LEACHING LINE ( No. of Lines ---r___________________ Length,_?f each line-----I�_r _--___._---__ Total Length ______ .----•------- 00 'D' Box .---'_------ Type`Filter Material°--____-- Depth Filter Material -----/-�_A�---- -------- -- ----•- DO Distance to nearest: ell _ h'�--~- Foundation __:��------------- Property Line ______ -------- £ SEEPAGE PIT Depth ._ - - ° Diameter _ B___ Number - /------------------- Rock/Filled Yes No i[] Water Table Depth ----- _D -=---45�v _�----------------Rock Size -_/1- -- - yr•-�- f Distance to nearest: Well _.f -----------------Foundation ___ r - Prop. Line ----- p ".� REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ______..----_-.-----------------•-) Septic Tank (Specify Requirements) -------- ------------- ------.-----------------------------------------------_ :_--------------------------- Disposal Field (Specify Requirements) ----------- - ---------------------------------------- ----------------- ` 3 . ---------------------------------------------- - - -------------------------------------------------------------------------------------------------------------------------------- (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 become subject Workman's Compensation laws of California." C Signed , -- /VC—_—Owner ,e Title ----------------------------------- (If other than owner) v A OR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - ---------------- -------------------------------------------------- DATE - �--==-'�.- BUILDING PERMIT ISSUED ---i, _�_ ----------- DATE ------------------------------------------- ADDITIONAL 7COMMEN ------------------------------------------------------- r ----------------- --------------------------------- -- _---------- -- - ---- - ---- - ------------------------------------- t- ____ -- - - ---------______--- --------- --- Final Inspection by: ____ __________Date _.___ y-_,7_ •---- SA JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 R . 5M