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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. .7. :-��3 ---------- --- --------------- (Complete in Triplicate) -------------------- Date Issued 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/LO/CATION .- 0141 w- 2„- _Ca L4 .�_ -.. --------CENSUS TRACT --------------------• ---- Owner's Name t-' -I2/Z�f ( _� - -- P��- ------ Phone r -------------------------- ------ Cit �e°�'---------------------------------------------- -- Address - _ t` � -----�' :�-10/,•� Y �� y3 � `� I .--- Contractor's Name -------- ---------- -=----- ---- -----.License #�-��-��--------- Phone .�---- --------- --- Installation will serve: Residence Apartment House'❑ Commercial:❑Trailer Court i❑ ' Motel ❑ Other -------------------------------------------- Number ------------------------------- -- ---Number of living units:.-__1---- Number of bedrooms ._-7-•---Garbage Grinder ------------ Lot Size _A Water Supply: Public System andname -----------------_--____- -------------------------------------------------------------------------•---------- Private E&' 'i ❑ y Peat Sand Loom Clay Loam ❑ I Character of soil to a depth of 3 feet: Sand Silt Clay ❑ ❑ Y ❑ Hardpan ❑ Adobe❑ Fill Material ------ ---- if yes, type ----------------------- � s (Plot plan, showing size of lot, h;bcation of system in relation to wells, buildings, etc. must be placed on reverse side.) i NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) SEPTIC TANK Size ----- ---- Liquid Depth -------------------------- PACKAGE TREATMENT { ] [ Capacity=---- ----=--------- Type ------ ------------- Mate r'aI------=•------------- No. Compartments Distance to nearest: Well --------------------------- _------Foundation ----- --"----- Prop. Line ---------------------- d I Length of a Fine-------------- ------------ Total Length ---------------------------W LEACHING LINE [ ] No. of Lines ---------- --------- - 9 Depth filter Material ---_-----_- 'D' Box ----------- Type Filter Material ---- ---------- p E Distance�ta nearest: Well --------------_-_ ---- Foundation ----------------------- Property Line - SEEPAGE PIT [ ] Depth -------------------- Diameter ------ --------- Number Rock Filled Yes [] No Water Table Depth -------------------------- ock Size -------------------- Distance Ito nearest: Well -•------- ------------------- ------ --Foundation ------ Prop. Line ---------- --------- REPAIR/ADDITION -- Date -------------------- -------------) REPAIR/ADDlT10N(Prev. Sanifiation Permit -.-----•�--- - C S ----- -••..--------------------------- 7 Septic Tank (Specify Requirements) ------------- - ---------------------------------•------------------- . 3 •• -- -------------- - ------------------ Disposal f=ield (Specify Requirements) -------------------------- ------------------------ / 9 -f ------------------- ----- ------------------------------------------------------------------------------------------------------------------------------------------- .� (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: "1 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 Work an's Compensation laws of California." Signed - Owner --------------------- ------------------------- Title ------ ------------ --------------------- --------------- - By (If other than owner) 1 FOR DEPARTMENT USE ONLY _ 1,111100.111111111 �� a DATE APPLICATION ACCEPTED BY --': ' DATE ------------------------ iBUILDING PERMIT ISSUED ------- -----------------------------------------------------------------------------------° =-' ------ ADDITIONAL COMMENTS ------- --------------------- -------------------------------------------------- --------------------------------- , ---- -------------------- ---------- ---------------- ------------ - ---- --"- -_- --- � + - ---------- ----------- ----- ---------------- - -------- ----------------------------------------- ---------- ------------------------------ - ----- ------- -- -------------- Final ----- ------ Final Inspection b _ - Date i SAN JOAQUIN LOCAL HEALTH DISTRICT L� E. H. 9 1-'68 Rev. 5M ' '-