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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No: 7/:7�00------- ----------------------------------- -------------------- - ------------ (Complete in Triplicate} i -------------------------------------------- �d2�1-7/ �a Date Issued5__ —Z�... This Permit Expires 1 Year From Rate Issued 4 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: :if3 ADDRESS/LOCATION . •��-7 77 --`-------"i�- �� CENSUS TRACT ---------------------- JOB fl Owner's Name ------- ------------------------------------------------- ---Phone ----•- I� k Address ---- '--- ---- City �'" �----- ---------------------------- •----- i Contractor's Name ._-- License # !- ------------ Phone -------------------- - -- Ii Installation will serve: Residence partment House❑ Commercial ❑Trailer Court ''.❑ i I Motel F-1 Other -----=--- ------------------------------ Number of living units:______-�-_ 'Number of bedrooms ---,3------Garbage Grinder ------------ Lot Size - --_--- - ii Water Supply: Public System and name ------------------- -----------------------------------------------Private Character of soil to a depth of 3 feet: Sand'F Silt❑ 'Clay ❑ Peat❑ Sandy Loam •❑ Clay Loam Hardpan ❑ Adobe ❑ Fill Material ------------ If Yes,type ---------------------------- J (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 [ I SEPTIC TANK'[ I Size------------------------------------------------ Liquid Depth -----------------•-------- 4:$ f Capacity - Type -------------------- Material---------------------- No. Compartments ........................ V p Y - ------ ------- Yp v Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line ...------- ------ LEACHING LINE [ } No. of Lines ------------------------ Length of each line----------------------------- Total Length .----.----—----------- I �1ri 'D' Box ------------ Type Filter Material --------------------Depth Filter Material ---------------------------------------•---- - Distance to nearest: Well -- ----------------{ Foundation ------------------------ Property Line ------------------ _ i f SEEPAGE PIT [ ] Depth _-- _-- --- Diameter ___----- Number ---------------------------- Rock Filled Yes C] No 0 fWater Table Depth -------------------------------------------------Rock Size ------------------------•------- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ---------- ------ REPAIR/ADDITION(Prev. Sanitation Permit# --------------------------------- ----------- Date ----------------------------------) i Septic Tank (Specify Requirements) ------------------------------------ ------------------- ------------- ( Disposal Field (Specify Requirements) -------> -z - `' �'' "' l� -- ---- ---�------- -- 3 ��-�--------�----------- ----------- (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 F� County Ordinances, State Laws, and Rules and Regulations of the. San Joaquin Local Health District. Home owner or [icon 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 E. as to become subject to Workman's Compensation laws of California." i] Signed ----------------- ---- ----------- Owner €1 ------------------------- --- -- - ---- -- -- Title ---- 'r - --- te -' �------------------------------------ BY -------------- i (If other than owner) a f -FOR DEPARTMENT USE ONLY f APPLICATION ACCEPTED BY - ---------------------------------------------------------------- DATE _J`._}-I'-7 --------------- € BUILDINGPERMIT ISSUED ---------------------------------------------------------------------------------------------- -------DATE ------------------------------------------ ADDITIONALCOMMENTS -- ----=`---------------------------------------- --------------------------------- ------------------------------------------------------------------ ----- ------ ---------------------------------- ----------------------------------------------------------------- -------------------------------------------------------------------------------------- ------------- ----------- iJ .. _�� --------------------------------------------- - ------------------------------ - ------.Date ----- ----------- 7 Final Inspection by -- ----------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT i' .1 E. H. 9 1-'68 Rev. 5M. 1 4