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FOR OFFICE USE: i t APPLICATION FOR SANITATION PERMIT ----------------- - ----------------------------- Permit No. -7 (Complete in Triplicate) ---------------------------------------------------------- This Permit Expires 1 Year From Date Issued Date Issued __ -_3.O_7I 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. r JOB ADDRESS/LOCATION , , _ ._Q ,� ldC111"��e------------------------------------CENSUS TRACT ----- -------------------- Owner's Name -__ ---------- --=-------------- -------- ------- --Phone ------------------------------------ Address ------- / -.-�--------------------------------------------------------------------- City 1/ ------------- ---------------------------- Contractor's Name ---------------------------------License # mss_ . Phone� ,O ;W. Installation will serve: Residence f�Apartment House Commercial ;❑Trailer Court 'F] Motel ❑ Other -------------------------------------------- Number of living units:____/-___ Number of bedrooms _—P-----Garbage Grinder -- Lot Size _ - "________________ Water Supply. Public System and name ______________________ ° ___ Private -- --------- - - Character of soil to a depth of 3 feet: Sand'❑ Silt-0 Clay ❑ Peat❑ Sandy Loam •❑ Clay Loam ❑ } a - 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 if public sewer is available within 200 feet,) PACKAGE TRE=ATMENT [ ] SEPTIC.TANK f ] >Size_______________At--------------------______ Liquid Depth --------------------------- W Capacity -__________ - Capacity -------------- ---- Type -------------------- Material---------------------- No. Compartments. ---------_--- . ,,: . Distance to :nearest: Well __,_._.__1----------------________Foundation ____________________ Prop. Lirie ___.___.____.__....... 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 I❑ Water Table Depth _-----------------------------------------------------Rock Size ------------------------------- Distance to nearer#: Well _____________________ ------------------Foundation -------------------- Prop. Line ____-___________..__- '-• � REPAIR/ADDITION(Prev. Sanitation Permit# -------=--------------------- --------- Date -------------_----------------_+-} �J Septic Tank (Specify Requirements) -------------------- -= °------- --f ----- -- -----�- -'� Y :. ------------A------�- r - Dir oral Field (Specify Requirements) A ----------------------------------_---------------------------------------------------------------------____________-______-__________-__.____._________.__.______________-__---__.-_.______ (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 .r 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: 3 "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." t Signed ---------------------- -------------- ---------. Owner U By -------------- -------------- - ------- ---- - Title (If o than owned R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --- -- --------------------------------- -------------- --- fDAT --- -- f BUILDING PERMIT ISSUED '--------- `-------------------- -------DATE ----------------------------- ------------- ADDITIONAL COMMENTS --- --- - - ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------- ------------------------------------ - - -- ------- ------------------------- ------ = Final Inspection by: ----------------------------------------------- -- - Date 71_. SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev:-5M ,. 1