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FOR OFFICE USE: OR OFFICE USE, --------------- ------------------------------------------ APPLICATION FOR -SANITATION PERMIT -------------------------------------------------------------- (Complete in Triplicate) Permit No.,7 ------------ --------- ---------- ------------------------------ ---- This Permit Expires I Year From Date issuedDate Issued/49-/ Application is hereby made to t he San Joaquin Local Health District fora permit to described. This application is made in compliance with construct and install the work herein County Ordinance No. 549 and existing Rules and Regulations. JOB ADDRESS/LOCATION .4/ Yle k ----- ------------------- -------CE NSUS TRACT' Owner's Name ----------- ............ Address ------------------- -7- e i: ---------------- -------------------Phone -------------- -------- ----- - A 21e Contractor's Name ------- --------- ---- ----------- License # Installation will serve. 'F'!T3 I? Resi ence e5"A - Phone -------- V Apartrh lent House Commercial :oTrailer Court ---------------------- Other --, : I- Motel ----------------------------------------- 4 Number of living units..- ----- Number of bedrooms t --- ' . t Water SuPPfY: Public System and name ----Garbage Grinder -,---------- Lot Size ----- -----------------------------------------------•-•---------Private Character of soil to a depth of 3 feet: Sand Silt 0 .-_ te Clay ❑ Peat[] Sandy Loam ,o Clay Loam Hardpan Adobe ❑0 Fill M' aterial ------------ If yes, type ---------------------------- (plot k Plan, showing size of lot, location of system in relation to wells, bu`Pdings,4 etc" must ust be placed on reverse side.) NEW INSTALLATION- (No septic,tank or seepage Pit permitted if public!PACKAGE TREATMENT sewer is available within 200 feetj SEP TIC"TANK'[A . f] - t I Size- _J---I--------- Liquid Depth Capacity lo1_00- Type6di. ---; ------------- Material No. Compartments ---- Distance to nearest. Well - � ------ ----------- ......... LEACHING LINE ------------------Foundation"-----f -------------- --------- No. o� Lines --------L--------- Length"6f--each'. line--- - ------------ Prop. Line ---- V Box --• ----- Total Length .............. Type Filter Material -4--",-,Pz Z--.,Depth,Fi I ter Material - . 'r " . 1 -9------------ ------------------ Distance to nearest: Well ----_"-&p ----------- Founclaitidn- ------------------------ Property 'SEEPAGE PIT Line Depth ---jpF: -------------- -------------- Diameter Number ----------/----------------- Rock Filled Yes M No 0 Water Table Depth ------------------?g? Distance to nearest:.arest: Well ____-._-__-_10-W---`--------- ----------------Rock Size ------- - -------- ----_-Foundation ......... Prop. Line ----------- REPAIR/ADDITION(Prev. Sanitation Permit# -------- ------ ----- ------------------ Date -------- Septic Tank 15pecify Requirements) ------------- Di� sal Field (Specify Requirements) ---------- - -- -- --------- ----------- ---- -------- -- ------- . ...... -- - - P ---- --------—_,*E�_ - --------- -- ------------- --------- -- --- ----------------- -------- ---T--------------------------------- - ----------------- - - -------------------------------------------------------------- • (Draw existing andrequired additibn on reverse side!- ---------------------------------------- - I hereby certify that I have prepared this application and that the workL will be dope in accordance with Son Joaquin County Ordinances, State Laws, and Rules and Regulations of the Son 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 f Workman's Compensation laws of California." Signed -------------- ------ - By _---- ---------------- ------------------------------- Owner Title y -------------- (If other than owner) r-------------------- ------------------------------------------ ---------- .1 DEPARTMENT - FOR DEPARTMENT USE ONLY .. ...... DA'TEE APPLICATION ACCEPTED BY__ IL APPLICATION PERMIT ISSUED . .. .................. ....... BUILDING PERMIT ISSUED # - -- --- - --- ------------------------------------------------------------ DA ADDITIONAL COMMENTS --------------------------------------------I------------------------ --------------DATE ------------------ ................... ----------------------------------- ---------------------------- ------ ------ ---------------- - --------- - ------------------------------------ --------------------------- -----------------------------------------�f_l......1041-------- ----------------------7------------------------------------------------------------------------------------------- FinalInspection by: ...... --------------------------------------------------------------------------------/2 - -- -----------------------------------------------------------------Date ISAN JOAQbIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.