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f FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT �f .- Permit No. _7�`-:_ �� --------------------------------------------------------- (Complete in Triplicate) ---------=----------------------------------------------- Date Issued _-_� -------------I----------------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the Sa\oaquin Local Health District for a permit to construct and install the work herein described. This application is made i ;mpliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCAI d6 TION g -5 L �---- ---------CENSUS TRACT --- ----------- r '" /!�y�� Phone ------------------------------------ Name ----- --------------------- `�---� ----"'�------- Owner's Address -------- --------------� '-- ---- 7`# /- p ---------- Installation ,r'`* �L' y -- Contractor's Name icense # � �-3cf Phone - - ❑ ❑ ,❑ Installation will serve: ResidenceXApartment House Commercial Trailer Court Motel ❑Other ----- ------ ------------------------------ / Number of living units:------I----- Number of bedrooms -------Garbage Grinder ------------ Lot Size __!W)(1-Y-0-------------------- Water Supply: Public System and name -------- - --------- -----G -------------------------------Private ❑ Character of soil to a depth of 3 feet: Sand'E] Silt❑ Clay ❑ Peat❑ Sandy Loom ❑ 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 seepage pit permitted ifp ublic sewer is available within 200 feet,) s / r PACKAGE TREATMENT { ) SEPTIC TANK [ j Liquid Depth _.__`7 ---------------- k Capac;ty _1_aoa Type �__ Material__ __ No. Compartments �________________ Distance to nearest: Wel! __°``--'--___/010-----------Foundation ----10_ --------- Prop. Line ___ � , LEACHING LINT: [ ' No. of Lines -----�2-------------- Length of each --------------- Total Length __ a. _______.._-.---- 'D' Box - -!____._ Type Filter Material ____-� _______Depth Filter Material _.__�1�______ S '_______________________ _ ______ Distance to nearest: Well QTf(iY/QO Foundation _____f a------------- Property Line ------------------ 11 i T [ ] Depth _______��'--_ ___ 1 , �-- Y1F'---- Number ---------�__--_ ___--__ Rock Filled Yes [� No d Water Table Depth ----------, a ---±.--------------------Rock Size ---1-1�_--__Y_3_.____-- Distance to nearest: Well --_ '_ -SP------------Foundation _y------_f-------- Prop. Line _`5________________ REPAIR/ADDITION{Prev. Sanitation Permit# _._.____ --------------------I-------------- Date --------=------------I------------ Septic ----_-_----Septic Tank (Specify Requirements) ---------------------------------------------------------------------------------- ---------------------------.-.--------------------------- 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 taws, 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 shalt not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ----------------------------------------- Owner._ BY ---------- --------- ,, ----_ Title _- -6rt rc�------------- ------------------------ - - - - - ------------------------- --------- (If other than owner) 01 am F R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --- +LRi --- ------------------------------------------- ------ DATE -----7""_Lyar ---------- BUILDINGPERMIT ISSUED -- ----------•------------------------------------------------------------------------------------------DATE ------------- ----------------------------- ADDI1-IONAL COMMENTS ------------------- ------- ----- ------------- ------------------------------------------------- -----------------A --------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------- ------------------ ------------ --------------------------------------------------------------------------------------------------------------Final Inspection by: --- __ —i..-__ _______ Date _._ _-�l_ "" ------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M