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FOR OFFICE USE: APPLICATION 'FOR SANITATION PERMIT ••---- --- {Complete In Triplicate) Permit No. .7 . `.. �J : = ..... ....................................•------ - .._._.-_ _. .. ..... �._.,o,._. This Permit Expires 1 Year From Date Issued Date Issued 4 Application is hereby made to the San Joaquin Local Health District for a per 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/LOCATION ...-.7.1.. ...i` . ! !.............-....CENSUS TRACT .......................... Owner's Name . ._ - .. - ----•...................................•-......,.....................................Phone . Address City Contractor's Name ...............License #j ./...��- Phone .. .. .�f� Installation will serve: Residence 0 Apartment House,] Commercial []Trailer Court 0 Motel []Other . ................... ................ Number of living units:._.1___ Number of bedrooms ._�3..._.Garbage Grinder ............ Lot Size ...... ..... Water Supply: Public System and name ---------------- Private 10q" Character of soil to a depth of 3 feet: Sand 0 Silt 0 Clay ❑ Peat❑ Sandy Loam fl Clay Loam 0 [ Hardpan Adobe 0 Fill Mcterial ............ If yes,type (Plot plan, showing size of lot,!location of system in relation to wells, buildings, .etc. ri ust be placed -on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) I PACKAGE TREATMENT SEPTIC TANK Size......_ [ 7 � ] �..�.6�-....x ..�._:_..:. Liquid Depth .......................... ' ! Capacity ---�-�-��/. TYpe -------------------- Material--- - No. Compartments .......... Distance to nearest: Well ------------------------------------Foundation ...................... Prop. Line ....................... I LEACHING LINE [ j No. of Lines _._�.._...._ ------ Length of each fine_.--- ..........:.. Total Length J.,0.. r 'D' Box _�_.__.___ Type :Filter Material .--. �oundation .-..Depth .Filter Material ..... ., .L r Distance to nearest: Well ---- _------•- ----------- ----.. Property Line ........................ SEEPAGE PIT [ } Depth F T �A)iameter -_-----------. Number ----�................ Rock Filled Yes J' No �� �` , Water Table Depth -•........................... ..................Rock Size ••-- ................ Distancs.to nearest: Well --------------------------------.........Foundation ------._..__--...._- Prop.,Line ............. it REPAIR/ADDITION(Prev. Sanitation Permit# ---------------------------------------- Date ----------........................ r. Septic Tank (Specify Requirements),-----• -------•- ....................................................... -•••---••-----...-•-••...............................: Disposal Field (Specify Requirements( ------------------------------ ................------------------------------------------------------....._. ---------------- ------------------ 1 - -•-•--------.._.............--..--------------.._----. . --------------------------------------- -------- -- --------•--------------•---------................................................................. _............._..------•-- } (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. Hance owner or liven- 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 Workman's Compensation laws of California." Signed - ---------------- - '�p� - Owner BY.----------------------------- Title ....... --- ---•--- --.... (if other than owner) FOR DEPARTMENT USE ONLY. APPLICATION ACCEPTED BY _.__. . -------- DATE .. .. .�..:_:•,,-: BUILDING PERMIT ISSUED ----------- - - - --DATE - --------------------------------- ADDITIONAL •----- - - ADDITIONAL COMMENTS -_. ........................................................................................................ : ..... _.......-.... ------------- -----•....... ...... .._...------ ------- .. ...... D �final Inspection by- -• --- ---- EH --E 13 2h 1-68 v. 5M I SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M