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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT --------------------------------------------------------- Permit No.7z" _ "Z_ .. (Complete in Triplicate) Date Issued _ _'"-7"- This Permit Expires 1 Year From Date Issued 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: JOB ADDRESS/LOCATION .__ . _____��- e - -C- '�. ...CENSUS TRACT --a-4--------•-------- -- - -- -- -- ------- Owner's Name r Phone - ------- --- _�G - --------- Address 2-6 tlu..� itY -- y -------------=--------------------- Contractor's Name -------------- - -------- ---- ----�.-` cp License # __� Phone ----------------- ------------ -- Installation will serve: Residence ❑ Apartment House .Commercial []Trailer Court ',❑ Motel ❑Other _-_______ Number of living units:------------ Nu+mber of bedrooms _____ ____.Garbage Grinder ------------ Lot Size ________________________---_____________.. t Water Supply: Public System and name ----------------------- ` ------------------------------------------------------------------ r:---Private ❑ k Character of soil to a depth r of 3 feet: Sand'❑ Silt[_1Clay ❑ Peat ElSandy Loam ' Clay Loom ❑ } Hardpan ❑ Adobe F1 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.) LV 1 NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) �N PACKAGE TREATMENT [ ] SEPTIC TANK'[ I Size------------------------------------------------ Liquid Depot{--- 4 Capacity - Type -------------------- Material-------------- .. --- No. Compartments----- ------ -----:.._. Distance ------------------------ U11 to nearest: Well ------------------------------------Foundation ---- ---- --------- --- Prop. Line .----f----=-----.--•-- LEACHING LINE [ ] No. of Lines ------------------------ Length of each line-----" --------------------- Total Length :-----•---- --------------- 'D' Box ------------ Type Filter Material ____________________Depth Filter Material ----------------------------------------- Distance to nearest: Well ------------------------ Foundation --------------:-------_ Property Line -------- .-• SEEPAGE PIT [ ] Depth ___________________ Diameter ----------------- Number _.._ ----------------------- Rock Filled Yes ❑ No CO] Water Table Depth ------------- --------Rock Size -------------------------------- Distance to nearest: Well ------------------------------ -Foundation --------------- ---- Prop. Line -------------- REPAIR/ADDITION(Prev. Sanitation, Permit# -------------------------------------------- Date ------------------- -------------- r ( Septic Tank (Specify Requirements) ----------------- --------------------------------- - ---------------------------------------------------------------------------------•- j _ __ r « - •--------------- Disposal Field (Specify Requirements) ____ - -- - - ----"""---- --------- �' ''� _ �r S` ----------- -- --- ------------------------------------ -------------------------------------------------------------- --------------------------------------------------------------- -------------------- 4 (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, aind Rules and Regulations of the San Joaquin Local Health District. Horne 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 shat) not employ any person in such manner as to become subject to Workman's Compensation laws of California." ' Signed ----------------------------cc Owner 'Yt------------------------------------ --------- --- Title ---+L --fi..G.. -� (If other than owner) FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _ - X17 --------------- DATE � -4n7� ------------------ BUILDING PERMIT--ISSUED --------------------------- DATE - ADDITIONAL COMMENTS -------------- ------------------------------ -----------=--------------------------- ______________________________________________-______-____________-_---_L_--______________---._______-__-_-------__________------________ _______________________________________ ______ _____________i_________ - Final Inspection by: _. _ �� Date -" <- -- ---- - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M