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C � FOR OFFICE USE: --------------------------------------------------------- Permit No, /_ APPLICATION FOR SANITATION PERMIT 7 ��__� --------------------------------- ----------------------- (Complete in Triplicate} / _.-._..__-_�----------------------- This Permit Expires 1 Year From Date Issued Date Issued !�_ 7-7-3 n07- o3a_o.6 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. 5.49 and existing Rules and Regulations-. o 4 � - %� JOB ADDRESS/LOCATI __ _______ fid_ -- ------------ -/� --- -----. ENSUS TRACT __-_ y ... Owner's Name -C --------------------------- ------------------------ ------- - ----Phone ------------------------------------ Address ----- Q ti ---------- City - 1'"'- Contractor's Name t -----------------License #A? r Phone -------------- Installation will serve: Residence [`Apartment House❑ Commercial'❑Trailer Court ;❑ Motel ❑Other -------------------------------------------- Number --------------------------------Number of living units:__!_______ Number of bedrooms --------Garbage Grinder ------------ Lot Size .._____.___.--__._- Water Supply: Public System and name ---------------------------------- -,---------------------------------------•----------------- ------------Private ) Character of soil to a depth of 3 feet: Sand'❑ Silt F] Clay F] Peat [I Sandy Loam -E] 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 if public sewer is available.within 200 feet,) l t PACKAGE TREATMENT [ ] SEP IC TANK [ ] Size____ ___ ._ ____ JC-_5______ Liquid Depth _____�'_______.__.._._.. 1 Capacity _.Zo___ __ TypeLLk.4e�d__ aterial_ __ No. Compartments ... .. .......... Distance to nearest: Well -----------�r �__ FoundationPhAml. _ ____ Prop. Line ____ LEACHING LINE j No. of Lines -------�_---_--__ Length of each line--__---- otal Length f ZO..._ 'D' Box ._- ._.__ Type Filter Material �Z--_Depth Filt rial -----1_9 __ _____ Disfance to nearest ell _____________�_ --__ Foundations __ ______ Property Line _____-- ... SEEPAGE PIT [ Depth --_ ______- _ Diameter ___ umber -- ----- Rock Filled Y No Water Table Dep Rock Size - t t Distance to nearest: Well __1_'a_�2 __ _ __ ________________Foundation ------lr- '_ Prop. Line ........ ?r. .... REPAIR/ADDITION{Prev. Sanitation Permit# -------------------- ______________________ Date _________________________ ------- SepticTank (Specify Requirements) ------------------- ------------------------------------------------------------------------------------------- ---------------------------- DisposalField (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 Wor can's ompensatio la of California." Signed --- ----------- ---- ----- --------- --------- - ----- --- - - - Owner f. BY - Title - -- �C+�t -- t Of other than owner) FOR DEPARTMENT USE ONLY APPLICATION .ACCEPTED BY DATE -> �-` --: --------------- --------------------------------------- BUILDING PERMIT: ISSUED -------------------- --------------_---------------------DATE -------------------------------------------------- ------------------------------- ADXYIONAL COMMENTS ------------=-------------- - ---- ---------------------------- -------------- - ---------------------------------------------- ---- ------ ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---- - --- - ---- -- -------------------------------------------------------------- ------- Finali .- Inspection by: -------------------------•---------------------------------------Date _�-. -------------- -- --- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. :9 1-'68 Rev. 5M i