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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ------- ------- ----- - -- . ----- (Complete in Triplicate) Permit No. 7_Z' �O ------ 1 --- - This Permit Expires 1 Year From Date Issued Date Issued .....7.v 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/LOCATION ._._. _ _ - qtr ---L �-P��.. --_--- -------------`.------CENSUS TRACT ----- -------- ---------- t Owner's Name �4+ ---+- ----J ----------------------------- I ---- ----- - Phone =�?- - ' �y -----`- ---- Address -- '°c� '� -------------- City � �; y f,. . Contractor's Name l �.�.rsf _� 'f ` -License - Phanea c7^ �� ! Installation will serve: Residence ❑Apartment House❑ Commercial :❑Trailer Court ',❑ r Motel F-1Other __________________________________________ Number of living units ----- Number of bedrooms ___....Garbage Grinder -.----------- Lot Size -/� ` ` Water Supply: Public System and name ---------------------------------------------------------------------------------------------------------------Private [� Character of soil io a depth of 3 feet: Sand' Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam-'13 TY Y 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,) S i PACKAGE TREATMENT f I SEPTIC TANK'[ I Size------------------------------------------------ Liquid Depth -------------.._------- _- a i � Capacity I------------- /Le _.- -1--- --------- Material--------- - ---------- No. Compartments -----------Distance to nearesfi: ---_ -_ Fou daon ---------------------- Prop. Line ------.---------------LEACHING LINE [ j No. of Lines _________ ___ Le gth of each line._ ________________.____ Total Length _____________________._D' Box _'---____-- Typr M terial __________________ epth Filter Material --------------------.-----------------...... Distance to nearest: ___ __________________ Found tion ___________________.__ Property Line --___.__..__.._.__...... SEEPAGE PIT' [ ] Depth _________________ er ________________ Nu ber -_--------__--__-------_---- Rock Filled Yes ❑ No I❑Water Talile Depth - ------------------------------- ------Rock Size -------------------------------- Distance to nearest: ___________________________ _______Foundation .-----------_---_--- Prop. Line _________.______.____.REPAIR/ADDITION(Prev. Sanitation Permit# __________________________________ Date --------------------.___________._� SepticTank (Specify Requirements) --------------------------------------------------------------------------------------------------------------:_---------------------------- Dis osal Field (Specify Require Iments) --------------------------------------------------------------- --------------------------------- ------------------ -----------�'�� ----- V---- -------�_ ----- �; p` { (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 Wo an's Compensation laws of California." t Signed -- ---- ----- -------- --- - --- --------------N---- ----- Owner BY '---- ----- --- -- - title -------- - --- --------------------------------------------------- (If other than owner FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------ ` 'Q DATE -- 6--l-77 BUILDINGPERMIT ISSUED -------------------- ------------------------------------------------------------------------------------DATE ------------------------------- ----------- -------- -------- ------- - --ADDITIONAL COMMENTSi ------- -- ------ -------- ---=----------------- ---- ----- -------------------------------------------------------- -------------- -- ------ -- r FinalIns - --- ----------------------------------.-Date - -- -------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1='68 Rev. 5M