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FOR OFFICE USE. APPLICATION FOR SANITATION PERMIT s Permit No. ---- --------- 7 - (Complete in Triplicate) ;14_. 11 _ v----- 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 rdinance No. 549 and existing Rules and Regulations: s --- --- ----CENSUS TRACT -------------------------- --- ---- JOB ADDRESS/LOCATION - ------------ Phone Owner's Name __. — -- - ----- ----- -- ----- -- - jaCity J------- --- ------------- -------------------------------------- Address -------- G - --- ------------ ------------ License # Phone I-- �^-`------- Contractor's Name ------= --- - - ---- -�-��------ ------P --------------------------------------- ---------- Installation will serve: Residence l�artment House❑ Commercial ❑Trailer Court l❑ t i Motel ❑Other'-y' t ----------- Number of living units:-._-,rt_.__. Number of bedrooms ___ _---.FGarba-g Grinder . _.... Lot Size ------------------ i Private ❑ E Water Supply: Public System and name __ __ -____ -- ----------------------- --- y -------- -- Peat Sand Loam ❑ Clay Loam ❑ Character of soil to a depth of 3 feet:' Sand'❑ Silt❑ Clay ❑ Y e ---------------------------- Hardpan ❑ Adobe Fill Material -_.----.-.- if es,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 -+f public sewer is available within 200 feet,) , I SEPTIC TANK't7 Size�4-- <10 �'J X &-------------- ---- Liquid Depth (.� PACKAGE TREATMENT [ ] ��, �/ No. Compartments _- -----•- Capacity __�"-606_ _ Type - ( Material_ t -/ L ' Foundation -�U-------------- Prop. Line -- ---- }}} Distance to.-nearest:- Well----------------'----------------- - -- i LEACHING LINE [� No. of Lines .-�--------------- Length o eachli e-- - Total length __ _- �__.__._.___._.._ ----- -- y D' Box Type Filter Material -------_�----.---•Depth Filter Material _ ------------- 3 • ,. to Property Line c1------------------ Distance�0__n_e__a__rest: Well ------------------ - Foundation ____-------------------- p tY + �-_ ^e �------------------ Rock Filled Yes No i❑ SEEPAGE PIT [1>' Depth;-. -'�---F-- Diameter: __.= - --- -- Number -- -11 Water Table'Depth ,�f?----------------,=--'------ Rock Size X- ----------------- • -----:-Foundation ------ -------- ---- Prop. Line ---------------------- REPAIR/ADDITION(Prev. Sanitation Permit# --------�--- ---------- -- --- Septic Tank (Specify Requirements) -------------- :�--------- Disposal Field (Specify Requirements) ._---- '- ------_.-_ --------------------- -------------------------------- ------------------- ------- -- ------------ -------------------------- ------ -------------------- ---------------- ----------------------------------- ----- --- - --------------------- (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 - ---YY r- -_ =------------ Title ------------ ---------------------- ------- BY ------------- --------------------------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 13Y DATE �� -- - ------ ----------------------------------------- BUILDING PERMIT ISSUED ----------------- ' --------------------- -----;7 -----------------------.._DATE ADDITIONAL COMMENTS _ C� l 3 3---------- _--.------ -- - -------- ---- - ----- -- ----- --------------- - _ - - -- ----- - — Final Inspection by --------------------------------------- -------------------------- SAN ------------------------SAN JOAQUIN LOCAL HEALTH DISTRICT E, H. 9 1-'68 Rev. 5M