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FOR-,OFFICE USE:, APPLICATION FOR SANITATION PERMIT p '' - --------- = Permit No.7�= J_ ? (Complete in Triplicate) . =--------- Date Issued 7,7 --------------------------------------- ---------------_-------- 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 ._�f2--�f__ _._G►�,t,� G '`�` -------------CENSUS TRACT ------_-------••-(-------- Owner's Name __ V// --- �� Cit Phone - Address -------------- �Ccz_- / 4;ie �i Y ' �� ------------------- Contractor's Name --,---- ----=--------License # -----;----- -------- Phone -------- ------------------ Installation will serve: Residence partment House ❑ Commercial []Trailer Court ,❑ FMotel ❑ Other -------------------------------------- Number of living units:---- Number of bedrooms ------------Garbage Grinder ------------ Lot Size ___________________________-----------_--- Water Supply: Public.System and name ---------------------------------- ---------------------------------------------------------------------------Private E] Character of soil to o"depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑(.. .Sandy Loam •❑ Clay Loam Hardpan ❑ Adobe ❑ Fill Material ------------ If yes, type ___----------------------- x (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse (side.) rt NEW INSTALLATION: (No septic tank or seepag pit permitted if public sewer is avail ble within 200 feet,) PACKAGE TREATMENT [ SEPTIC TANK f ] Size----------------------------------------'- ----- Liquid Depth -------------------------- 1 , �. ,Capacity - ----- ------ TYp,. Material--------------------- o. Compartments i Distance tof nearest: Well ------------------------------------ Foundation -:-- -------------- Prop. Line ------------- ........ LEACHING LINE [ ] No. of Lines`----- ------------- Length of each line---------.--------->.__ Total Length ------------- ------------ LEACHING Boz ______ _--- hype Filte Material --------------------Depth Filter Ma erial ________-_________.---------•-•---=------•- I. Di tance•to-nearest:-We[l- :_-----_______________ Foundation _____________________ ___ Property Line ---------------;-_.----- / � tx SEEPAGE PIT [ ] Depth --`------------------ Dia ter ---------------- Number ---:'------------------- __ Rock Filled Yes ❑ No �[] 111�� WateraTable Depth ------ --------------------- ----------Rock Size ---- ------- ------------------- Distance to nearest: Wel ___________________________________Foundation ,____ ---------- Prop. Line ---------.•-_._______. REPAIR/ADDITION(Prey. Sanitation Permit# __a----- --------------------------- ---- Ddte----'---------- ------------I ISeptic Tank (Specify Requirements) ---------------- ---- --------------- ---------------------------------------I----------'-----------------_<---------------------------- Disposal Field (Specify Requirements) .___ V __dJ__ �'�.-a` --------------------- -- --s-.eo-,_._.4_____._____i__-___ --- L - (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.becoire sub-eto Wo pn's Compensation laws of California." l I Signed'-_ .. _ - r - _ ._, --Owner-- ----------------------- Title ---------------- (If other than owner) M DEPA MENT USE ONLY APPLICATION ACCEPTED BY --------------------- 4 ------------------------------------------------ DATE -------�J--- ----� --------- 14VBUILDING PERMIT t ISSUED -------------- ---------------------------------------------------------------------------------------------DATE ------------ ------ - ADDITIONAL COMMENTS - --- - - ---- ---------------------------------- ----------------- ----------------------------------------------------- ---�-}---- r-- --------------- --------------------------------------- -- ---------------------------- ----------- - -- -- ---- -------- --- ------ ------------ - ------------------------------------- - -----------------Final Inspectio - --- --------- ------------------------------------Date ---- ----------- SAN ---------SAN JOAQUIN LOCAL HEALTH DISTRICT I E. H. 9 .1•'68 Rev. 5M