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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 7 ----- :- . ;---------------:.------ Permit No:��- (Complete in Triplicate) ----- ------------------------------------ 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: . __/. — _., I __ --JOB ADDRESS/LOCATION __ y �� 1��r �-----------.--' -q --CENSUS TRACT ------------------------ Owner's Name ---- -------- --------------------------------------------- I Phone ----------- SIi ------------------------------------ ---•-- Address ---- - - - - - City ----- ---- r = Contractor, Namer----S- 1 ----T/ '------License # - _7 _ -- Phone - ---- ------- -- Installation will serve: Residence K Apartment House❑ Commercial;❑Trailer Court i❑ Motel ❑ Other -------------- ---------------------------- r Number of living units:.-.I_.____ __Number of bedrooms - ------Garbage Grinder IV --- Lot Size 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 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.) I4 r NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ SEPTIC TANK [ ] Size--------------------------------------- Liquid Depth ------------------------ Y - Capacity T - --------------- e -------------------- Material---------------------- No. Compartments ----------------- P YP Distance to nearest: Well ------------------------------------Foundation ------------ --------- Prop. Line -_-----------_-------- LEACHING LINE [ ] No. of Lines ------------------------ Length of each line---------------------------- Total Length ----------------•----------- `{ 'D' Box ----____-__ Type Filter Material -____--_--._---___Depth Filter Material -------------------------------------------- Distance to nearest: Well ------------------------ Foundation ------------------------ Property Line 41 _-.------------------ ' -_-- Rock Filled Yes No SEEPAGE PIT [ } Depth --------- ---------- Diameter ________�_� Number -_______._____.-----.- ❑ Water Table I Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well ......-----------------------------------Foundation -------------------- Prop. Line --_--------.---------- REPAIR/ADDITION(Prev. Sanitation Permit#I— ----------------------------------- Date ----------------------------------) Septic Tank (Specify Requirements)t__''- --------------i-----------.�}-�-o--L-/----- -----------�--------------------- --�-------- �*--f� ----- ---- ---------------------- Disposal Field {Specify Requirements) ��--- A- �/�Z 'ZT -'IT- - ---------------- 5x- - ----��3- I f: y ________________________________________________________�____----___--_-_-____--_- k ____--- __ ______ ______________ _ _ _ _______________________------_----_-- --- -___- ----------- --------------------------------------------------------------------------------------------- (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 ortlicen. 3 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 --------------------- Title -------------- --------------- ------------------- -------------------- (! ther than owner) 1 ! FO .DEPARTMENT USE ONLY I ----------- DATE 6 -------- --------- BUILDING ACCEPTED BY ...C__.__��--'--�--- ---- --- ----- ------ - - ---- ---------------------------------- -------- PERMIT ISSUED ------------ ------- ------- -------DATE ----------------- --------- --------- ----- --------------------------------------------------- ADDITIONAL COMMENTS ------------------------- -----------------------------------------------'-------- -------------------------------------------------------------------------------- ---------------------------------------------------------------------- t ------------------------------------ i I ------------------------------------- p-,-- -1-f { Final Inspection by: - Date = N JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M. 1W A ,4 4 1 r•''��