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' FOP OFFICE USE: N APPLICATIOPi FOR SANITATION PERMIT Permit Na. ' (Complete in Triplicate) ------------------------------- P p 7-3 Date Issued -.._.-----_--- This Permit Expires I Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a per 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/LOCATION ----------- ------------------------CENSUS TRACT -------------------- Owner's Name --------- - ---- ------------ -------------------------------------------------- -- --..__Phone ' Address -----f_Z f-- - ------- �"��'�------------------------ City Contractor's Name .-_-�� 3�.1-_-- --- t --.License # -ir"-�1 a"- -__ Phone . .---- Installation will serve: ResidenceXApartment House❑ Commercial []Trailer Court i❑ Motel ❑ Other -------------------------------------------- / Number of living units:_____ -- Number of bedr000mss�___2..____Garbage Grinder -7177 Lot Size ___w _ -l- --------- 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 ___-______________________ 4i (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) O NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,J int PACKAGE TREATMENT [ SEPTIC TANK DD Size r __x.U-W -_____ Liquid Depth __--s___________________ T e/!Material -� No. Compartments , Capacity/jlptj�q L_ yp __--_- Distance to nearest: Well ----- ______-__-______Foundation -------- Prop. Line ----4______________ LEACHING LINE No. of Lines ______ _.________-__ --- Length ofeach line------/dfQ------------- Total Length0.____....___.____ 'D' Box __---_ Type Filter Material _/Qp _____Depth Filter Material t _.-/R----------_____________ _________ — r Distance to nearest: Well _ �___________ Foundation .../__A_0'_________ Property Line SEEPAGE PIT 6e Depth ______ Diameter ppNumber -------I----------------- Rock Filled Yes No I❑ Water Table Depth /_ - --------------------Rock Size r------------ r � . Distance to nearest: Well- ______________________-----Foundation ___ ________ Prop. Line _____---________.___.. REPAIR/ADDITION(Prev. Sanitation Permit=# -------------------------------------------- Date -----------------------------------) Septic Tank (Specify Requirements) --- --------------- --------------------------------------------• ---------------------------------------- ------------- DisposalField (Specify Requirements) ---•--------------------------------------------------------------------------- ---------------------------•--------------- --------------------------------------------------------------------------------------------------------------------------------------------- (Draw existing and required addition on reverse side) 1 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 ------ ------ �ri� a Title (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - - ------ -- ---------------- -----. DATE _. }a --------- --------- - - ------------------------ BUILDINGPERMIT ISSUED --- ------------------------------------------------------- ------------------------- ------------DATE ------------------------------------------ ADDITIONALCOMMENTS - -- -------------------------------------------------------------------------- ---- --------------------------------------=-------------------------- --------------------------- ------------------------------- ----------I P Final Ins pec#ion by; ------•---------------------------------------Date SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M