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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT - 7 --••.... ............... (Complete In Triplicate( Permit Na. 7 _....---•-••---•.:...:..:.................ii.. . ------ ............... This Permit Expires I Year From Date Issued Date Issued .A.Z..Z6... I f 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 .�' ...... . , TRACT .....................:.... COwner's Name -... . ...-• � ------------- .......... ........•.............................................. hone .......... Address .I� '�t/ �-C .......... ...... r...- - City ... _ . !1—r ... . Contractor's Name ........ ... -•-- ... = ..-.--. ...:. �r..... ...... ! .:......License ........................... Installation will serve: Residence Apartment House,] Commercial`❑Trailer Court` ❑ i Motel ❑Other........................................... Number of living units.-. INumber of bedroois Garbo eGrinder ........................ ......... Water Supply: Public System Sand name ....:............................................................. ............................................Private a Character of soil to a depth of 3 feet: Sand-O t-19—Clay D� Peat DSand Loom fl, Clay Loam ❑ Hardpan Adobe # 0 Fill M4terial ._•-.--.. If yes,type.............:. ............ (Plot plan, showing size of(lot, location of system in 'rel`ation to wells, buildings, etc. must be placed_ on reverse side.} ' NEW INSTALLATION: (No aeptic tank orseep a pit permitted if public sewer is available within 200 feet,# . PACKAGE TREATMENT [ I SEPTIC TANK 5ize. ` q Capacity �...a-.a.._.--- Type _ Material. .. ............... No. Compartments .. .............. 1 Distance to nearest: Well ----------J.-Q.0. Foundation ....LCl. ... ... Prop. Line ...:5..�.......__... 1 LEACHING LINE [I No. Iof Lines ._----�---------.. Length of each line------�./ •--........ Total Length ..,� ....... 'D' Box .._-.1.... Type Filter Material ...... a�......Depth .Filter Material ._(�'�................................ Distance to nearest: Well _.....� ate. Foundation .......La Property Llne .... ...... SEEPAGEPIT [ Depth _. Diameter Number ....... . ..-.- ..... Rock Filled Yes [ No ❑ _. ...- Water Table Depth ................ Gzr�_ .............Rock Size ..I-.. '-..�?.�`_..... Distance to nearest: Well --------- Foundation 1Q Prop. Line ....._� - REPAIR/ADDITION(Prey. Sanitation Permit# ............................................ Date ..................................l Septic Tank (Specify Requirements).....................__...._......................................-......I.---•-•-- ..._........................... DisposalField (Specify Req.uirements] --------•-----------------•-•-••--- ------- .....................................__................................................ -----------1............I--- ------- - -------------•---------...---•------------•---------------------------------••-•----....--••-------•----------•---------•-•:.••....--•-•---....---- II .................... ...... .......I..............I... ................ .. . ............... ---.....,.,... ---------------- = _.. _ 1 _ _ (Draw existing and required addition on reverse sidel I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State Lars, 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 sholl not employ any person in such manner as .to become subject to Workman's mpensation laws of California. Signed Owner BY I� = title ----------- -------- I' - -------- Ilf other than owner) FOR DEPARTMENT USE ONLY u APPLICATION ACCEPTED ....................................................... DATE .(.'_ --- ------------------------- BUILDING PERMIT ISSUED ..u�....... ----- 0 " ----- - --- - -DATE . . .................................. ADDITIONALCOMMENTS .... ............................................................ ................................................... .................. , -- . -- ------------------------- --- ---- --- ..--- --- ---------------------------------- .-.--....------...----.-.......-..-.....--------------------------•----..-.-.. - ......- -------------- ----------------------- ----- FinalInspection by. ---- a0 --- ---- --------•---•--... -----------------------•-----•..................-- ---Date . ..�f.�-.t--....... --------------- EH 13 2h 1-68 Rev. SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7li 3M i