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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ............................... tCon�pleto in Triplicatel Permit No. 7 ......- This Perrrtlt Expires 3 Year From Date Issued Date t ..__..... Issued ----� �� Application is hereby made to the San Joaquin Low,I Health District for a permit to construct and install the work herein ' described. This application is made incompliance with County Ordinance No. 549 and..existing Rules and Regulations: } o � �QQ .....: .........CENSUS TRACT ................. ._--�_-- JOB ADDRESS/LOCAT-i N ... � �'-•_•n- ----�-....��. .....-.__. Owner's Name ...._.... ..._----•-. -- ........................................... .............,,,;..Phone ............._...-•----_-_.. .a. .Pho = Address _...-....�. �.� ... n ;� ..�._._._. C10 ity �- ...... . . . .---_.. . Contractor's Name __ - _. � .............License# ............. Phone._........................"._: Installation will serve: Residence( Apartment House[] Commercial❑Trailer Court J I q .. Motel Q Other f........................- ...................... Number of living 'units:_-_1.-_._.'Number of.bedroorns _ :.Garbage Grinder ......__.... tot Size ............:.. ............ Water Supply: Public System and name.:.--•....:......................................:...........:.__._..............._....."....:.. ".... L� i ...s.....Private Choracter,of soil to:a depth of 3 feet: Sand.bSilt❑, Clay ❑ Peat❑ Sandy Loom 0 Clay Loam Q 1 Hordpah-jam 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 $14 NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,j ; F PACKAGE TREATMENT [ ] SEPTIC TANK i }. •••- ................... ; Siae..-----•.........:........................ Liquid Depth .._. No. Compartments Capacity._ !-.--Type. __ Material....................... p 1 r Distance to nearest: Well ..Foundation Prop.:Line LEACHING LINE [ ] No. of Lines ...............•.......... Length of each line.........................._ Total Length,, ............................ t 'D' Box ....'........ Type Filter Material ...................:Depth Miter Material ..-.........._._-._...................... . . Distance to'nearest: Well......................... Foundation ____- ...... Property Line SEEPAGE PIT [ ( Depth ...................... Diameter ......... Number ................... ......... Rock Filled Yes ❑ No 1. Water Table Depth ` i - 1........ltock Size ............... Distance to nearest: Well .......................�' ........foundation .........----:------ Prop. line ..................... REPAIR/ADDITION(Prev. Sanitation Permit ........................ . ...........:.... Date _---------------- ....... ........ , Septic Tank (Specify Requirements) •• -- •--......... ........ -;. .----•........................ f ..... -- - Disposal Field (Specify Requirements) ' ..........................I................ _ 11 i t •-- `......................."-•------ -- -_-'"_._.-. �............................................................. ..................... i '(Draw existing and required addition on reverse side) 1 hereby certify that I have prepared:th€s application and-that the work will be done In accordance with San Joequi County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health,District. Home owner or Been. sed agents signature certifies the following: r, "I certify that in the performance of the work for which this permit is issued, I shelf not employ any person in such manner ! as' to become subject to Workman's•Compensation laws of Californla." r ° OwnerSi nod ...... ----------- B --------------------- --- � � ' � .. - B Title ... .._."....r�... ............. ` .. -- 1 Y � (If other than owner) FOR-DEPARTMENT DISE ONLY. { [ AOPLICATION ACCEPTED BY------------ ::--......- = DATE,3 3 BUILDING 'PERMIT .ISSUED --- .. ........... � ---•---'•-'-._.-----•------....................-'--'...-'-...._.....DATE --------- -_---------------------- ADDITIONALCOMMENTS .--...------------- ------------------------ -•-•-----•-......----'.........-------•-•- •---• ••--------------•-------••---.............................------- ------------ --•------------------•-----------------`------ -----------------------•--•-.......................................................................... ................................ ... •-•................... ---------------------------------.------ -_---_._.-.._._-..... ----- ..................... 1 incrl Ins ection b -------------------- --------------Date ' -...... :,_.-...-.. EH 13 24 1-68 Rev. 5m AN JOAQUIN LOCAL HEALTH DISTRICT 874 3M