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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT - --- - - ---•- Permit No. ..7.7.:�03 (Complete in Triplicate) - ---- ----- — /S 7y ---------- -- This Permit Expires 1 Year From Date Issued Date Issued ._S_ __... 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/LQ �ATION ---- 7�j1 ------------------- ------------------------------------------------------- ------CENSUS TRACT ----_------------------- j Owner's Name7�. 2lJc - - --------- -----�---/�/2.f�--------------------------- ------------------•---------...-----------------..Phone Address ----- n7 / �- City Contractor's Name -------- } -_iC..___(!f�_ � /Ae_------------------_------------License Phone Installation will serve: Residence CRApartment House❑ Commercial ❑Trailer Court ;❑ / Motel ❑Other Number of living units:------ Number of bedrooms 3.-----Garbage Grinder --- Lot Size -----------------------------__.._---_--... Water Supply: Public System and name ------------------_--•---- ---•--- ---------------•------•---•----Private P57- 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 [ ] SEPTIC TANK I ] Size____________ -- ---------- --- --- .. ___ __-__. Liquid Depth _..__-..___-__._________-- ---- Capacity -----------------.-- Type -------------------- M erial---- _ --------- No. Compartments ---------------------- Distance to nearest: Well __.---------_--------- ____________Foun ation --------------------.- Prop. Line ._--______,_.._�_..._ LEACHING LINE [ ) No. of Lines ________________________ Length o each line.-_ _.-------------------.. Total Length ----------- ................ s` 'D' Box ------------ Type Filter Materia ___________________ epth Filter Material -------------------------------------------- J Distance to nearest: Well ___________ ________ _ _ Foun ation ------------------------ Property Line --____-_--__-____-.----. SEEPAGE PIT [ ] Depth ____ _ ___--------- Diameter -------_......_ mber ------------ --------- Rock Filled Yes ❑ No C3 ` n Water Table Depth ----------- -------------------_ -------------Rock Size -------------------------------- Distance to nearest: Well -------------------- ------------------Foundation ._._...-_____--.__.- Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ___ __ _______________ ____________________ Date ----------------------------------) Septic Tank (Specify Requirements) ---------- --------------- ------------------------- ------•------- -- ....-------------- Disposal Field (Specify Requireme ts) ._�CP._ �/_7 n_.-F___C ._!�_.n_.___ � ____ P ` --�' 3 `` -------------------- 5------------ l.nc--- ---- -- (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 ---- - s - ------- Owner -- - -- --- - ---- ---------- -- ----------------------- -- BY ----- ------ Title ........ - --- -------- - -------------------------------- --- (If other than owner FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ... ---------------------------------------------------------- DATE - Y_-.2..y---- BUILDING PERMIT ISSUED . -- -------•----....-•--------------------------------•-------------------------------------------------DATE ADDITIONALCOMMENTS ...--------------------------------------------------------------------------------------------------------- ---------------------- --------------------------- ---------------------------------------------------------------------- ------ ------------------------------------------- --------------------------------------------- ---------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------ --------------------------- Final Inspection by ��- ........................................Date - SAN JOAQUIN LOCAL HEALTH DISTRICT CIO E. H. 9 1-'68 Rev. 5M