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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 6 ------ ---------- ------ ------------ - ------------ --- Permit No. -7-1b (Complete in Triplicate) ---------------------- ------------- - ------ --- ----- Date Issued .-9"G'_=`-��--.. This Permit Expires 1 Year From 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: JOB ADDRESS/LOCATION �So----------- ----------- -- ---- --- --CENSUS TRACT ------------------------- - -- -- ---- - Owner's Name _. �- - - ----- - - ---- ------------------ --------- ------------ ---- - - Phone --. Cit ' ----------�.----------- Address ------------ ------.----------- ---- ----------- -- Y Contractor's Name _____ ------ --- l` � License # � �, '>_ Phone -----------------•- Installation will serve: Residence Apartment House Commercial:❑Trailer Court ❑ Motel ❑ Other -------------------------------------------- Number ------------- ---------------- -- ------ Number of living units:___" ----- Number of bedrooms -4_.....Garbage Grinder ------ Lot Size -- -_--.- ---- Water Supply: Public System and name ---------------------------------------------------------------------- --------- -----•------- ------- ----Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam Clay Loam:[] ' Hardpan ❑ 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 side.) NEW INSTALLATION: (No septic tank or seep pit permitted if public sewer is available within 200 feet,) �.� X ----- - ----- Liquid Depth (l, PACKAGE TREATMENT [ ] SEPTIC TANK'[ Size__ _ _ -__ --- ---- _V Capacity %. 0 -G-.Type - _ Material 'K�f�c- No. Compartments _ '------•- ---- t, _ ----Foundation ----/d----------- Prop. Line __ ------------- istonce fio nearest: Well Length of each line..___ �'s� ` Total Length ------------ LEACHING LINE [ No. of Lines ------�------ --- I --�----- ""-•_" 'D' Box "-- Type Filter Mate_rial�;--!-Sf/Z_.,!---Depth. Filter Material _.__r-f------ -- -------------j °' V -------� Foundation--�-��'-�-- Property Line. ------ ------- Distance to nearest: Well - ------- -- - -- - SEEPAGE PIT [ ] Depth Diameter "__________" -- Number _---------------------- Rock Filled Yes E] No .❑ WaterTable Depth ------------------------------------------------Rock Size -------------------------------- -------------------•-Foundation - ------------- ---- Prop. Line Distance to nearest: Well ____"________--_ " - i ------------------- Date ----------------------------------) REPAIR/ADDITION{Prev. Sanitation Permit# ---------------------- - , Septic Tank (Specify Requirements) ------------ ------------------ ---------------------------.----------------- f. 3 4. __ Disposal Field (Specify Requirements) ----------------------- --=--------------------------------------------------------------------------------------- ----------------------------------------------------- — _-. ---.#- - ----------------------------------------- ----------------------------------------- - ---------------------------------- -------------------------------------- --- --- - - (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, 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 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed -------_-- ----------------"--------Q ------- --Owner_'_""_. _ .. in ------------------------- BY �1i�-. R.d- t,v - ------------------- Title ='. (If other than owner) i FOR•'EiEPARTMENT- USE ONlY a r ` ------------------------ APPLICATION ACCEPTED"BY'` - ------. DATE``_ ��r- --------- BUILDINGPERMIT ISSUED ---------.------ ---------- ---------------------------------------------------------- -.DATE - ------------------------------------------ ADDITIONAL COMMENTS ---------------------- ---- - ----------------------- -- --------------------------------------------------------------- ---------------- --------------------------------------------------------- - - Date ---- ---- - ---- - ----- ------ Final Inspection by. ----- ------ ------ ---- -------------------- ------- ----- ----------- - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M