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FOR OFFICE USE: L APPLICATION FOR SANITATION PERMIT t Permit No: .-7/-411---_. ----------------------------------------- --------------- (Compiete in Triplicate) -------------------------------------------- p Date Issued This Permit Expires f 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: 7 r � �7 , ---- --- CENSUS TRACT _ ---------------------- q e� s JOB ADDRESS/LOCAT N .-p�-5� � Phone ------------------------------------ Owner's Name NiA 4" - -- -- - - --'-------------------------- - --- --------- Address f Y - - ---- - ----------------------------------• ----------- Cil �j Contractor's Name _ ✓ Q� e�----------------------------- -----License # � Phone Installation will serve: Residence partment Housef-] Commercial Trailer Court 0 ! '�*_i Motel ❑Other ------ ------------------------------ ---- 3 `" /- Lot Size> .G Number of living units:---- Number of bedrooms, - -----Garbage Grinder -_ - ---_ V .. _ Private 91— Water Supply: Public System and name ----------- --I f y ❑ ❑ y Character of soil to a depth of 3 feet: Sand' Silt Cla %, Peayt� Sand Lo{m ❑ Clay Loam ❑ Hardpan Adobe ❑ Fi11 Material, __- --- If yes, YP ---------------------------- r ------- ------ - j F buildings, .etc. must be placed on reverse side.) (Plot plan, showing size of lot, hcation of system in relation to wells, NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) �J _ ' _ L;quid Depth v PACKAGE TREATMENT f I SEPTIC TANK'[l.� 'ze_ _ -- -- I No.- Compartments 1r---------•---- V) 17 Capacity�I.0------ Type ti j- Matena11�� r Prop. Line --------------- Foundation - /,��------------ , O y Distance�to nearest: Wel --5_ j /` k LEACHI G LINE f�No. of Lines --------- -------------- Length of each line. - Total Len�g�th -- =- t i `� �---- --------- Ih b' Sox14 Depth Filter, - �!- Type Filter Material l ----- P -s - QQ f r Foundation - � -- -- -----. Property Line A&------- •=-• l Distan yto nearest; Well -/- --------- Diameter Number - _- -- ------ Rock Filled Yes, No SEEPAGE PIT [V Depth --- - -- A p - ----- ---------Rock Size11'""�--------------- 1 � Water Table Depth -_ .- -- - - `--- Distance nearest: Well / ------ Foundation _�v-a�------ Prop. Line _. .-- ------•----- � t` ` 4 i 1 Da te -.t ) REPAIR/ADDITION[Prev. Sanitation Permit -•-----•---------- ------ ----- I � Septic Tank (Specify Requirements) --------------•- ---- --------- ---------- - -------------------------- -•--------------------------------------------------- j ----- --------------- Disposal Field (Specify Requirements) ------------------------------------------------------------- -------------------------------- - ----- ' ------------------------------------------------------------ I 1 i ---- --------------------------- it - ----------------------- --------- ----------------------- ------------------------- ------------- ---------- existing and required addition on re,erse side) k l hereby certify .that I have preparedithis application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws;Iand 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 performanc .of4the 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. iOwner Signed -- -- ---------------- -------------------- T --- - --------- -------------- Title - -- ---------------------------- (If of than owner) FOR DEPARTMENT USE ONLY ----•--------- APPLICATION ACCEPTED BY -- - -------------------------- ----------------------------------- --------------- DATE BUILDING. PERMIT 155LIED ---- - --------- ---------- --------- ---------- ---------- ------ ------------- --------------DATE ------------------------------------------- ADDITIONALCOMMENTS - .. -------------------- -------------------------------------------- ------------------------------- -------------------------------- -------------------------- i ------------------------ ----------------- ---------------------------------- ------------- -------------- - -- --- Dater--�----+- -- ---------------- -------------------------- ----------------- Final Inspection by: --- -- --- ----- ----- -------- -- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M