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FOR OFFICE USE: !: APPLICATION FOR SANITATION PERMIT ----------------- ------ Permit No: 7- --------------�? (Complete in Triplicate) This Permit Expires 1 Year From Date Issued 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 Ordinance No. 549 and existing Rules and Regulations: I JOB ADDRESS/LOCATION ------I` - ----------ac(--------------------------------CENSUS TRACT --------------- ------ OwnerOwner's 's Name ---�rtz-------- -------�-Z----------------------------------------------------------------- - - ----�---- �/Address - ---- -- -- - - - - �-' Q ;- �-�-----P_�- --------------------------:---- City -�� ---------- ---- ------------------------------ Contractor's Name ----L�1 ___C- -a-- ;: . � ��1---- ---------------------- ------ License #�y�9r_ Phone .��3_-- 6' e Installation will serve: Residence ❑Apartment House❑ Commercial❑Trader Court Ij I Motel ❑Other ----------------------------------------- Number of living units:-----I--__ Number of bedrooms ---Z-----Garbage Grinder ------------ Lot Size -------------------------------______________ Water Supply: Public System and name ------------------------------------------------------------------------------------------------------------Private ®. Character of soil to a depth of 3 feet: Sand Ie' Silt]] Clay ❑ Peat❑ Sandy Loam fl Clay Loam;Q Hardpan❑ Adobe-❑ Fill Material ----- ------ If yes,type____________________________ ; (Pl'ot 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 pert permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK f ] Size___ _ _ /- _-__-_- Liquid Depth ---,----- Ca act Material__ No. Compartments 2r Capacity f��---•-- TYI� -�-"--------f - - / P � Distance to nearest: Well _---___-s��_^ ___________________Foundation ___C�___________,Prop. Line ---15------:-______ LEACHING LINE [ ] No. of Lines ------1--------------- Length of each line------7 _------------- Total Length ;___ Q_--__---__--__-- 'D' Box ---_'------- Type Filter Material L _-Depth Filter Material ---/1��__---------_------------------ _____ i l Distance to nearest: Well ----6'0 Foundation -__-_1v_f------- Property Line, _-_J_` --------____-__-- SEEPAGE PIT [ J Depth ___- ______________ Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No I❑ Water Table Depth•--------------------------------------=--------Rock Size -------------------------------- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ------------- -------- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------1 SepticTank (Specify Requirements) ----------------------------------------------------- ---------------------------------- -------------------------- ------------------ Disposal Field (Specify Requirements) --------- ---------------------------------------------------------------------------------------------------.------------------------ - ----------- .................. -----------------------------------r----------- ------------- --------------------------------------=-------------------- . f ;7 ---------------- - ------------------------------------------------------------------------------------------ 3 (Draw existing and required addition on reverse side) I hereby certify that 1 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, 1 shall not employ any person in such manner as to become suble t to W man's Compensation laws of California." ' Signed . - �' - _ Owner , By --••- t .•_.._._.. ----------------- -------- Title --------- ----------------------- ------------------------------------- - (If other than owner FOR .DEPARTMENT USE ONLY 42 APPLICATION ACCEPTED 8Y -_ ------------- DATE _.7_/ -- ,1--_---_ BUILDING PERMIT ISSUED -•-•- -ff- -!---_---•--....---•- DATE ADDITIONAL COMMENTS _ ------ -- ----------------- ------------------------------------------------- ----------- ......... . --•--------C------------------------------- I:— Inspection by: .... `�--n��Y Date j --J-3---- --- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M