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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT /7as� (Complete in Triplicate) Permit No. 7_________________ _____________________ ----------------------------- i This Permit Expires i Year From Date Issued Date issued ')v 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 rind existing Rules and Regulations: JOB ADDRESS/LOCATION -/--------- ----- ------CENSUS TRACT --------------- ---------- �+� � / � Owner's Name ----- - 2 - - Phone 's Address --------------- City --- --- --- C. Contractor's Name ------ t!r.•-s.ee�j .-tS��- Gt_.License #,,- r11_7------ Phone OW-17,,7412G r_. i Installation will serve: Residence Apartment House°❑ Commercial ❑Trailer Court i❑ Motel ❑Other ------------ --------------------------- Number -----------------'-- ---Number of living units ... Number of bedrooms _1�.2-----Garbage Grinder .--___--_ Lot,Size r 17X./!!Kc/--------- I Water Supply: Public System and name _.__ _ ......... ---------------------------------------A- - ---_--.,---Privateo- Character of soil to a depth of 3 feet: Sand* Silt E] Clay ❑ Peat ElSandy Loam*Clay LoamEJ 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,) PACKAGE TREATMENT SEPTIC TANK Size_ [ rf ------------ Liquid Depth ----------------- Capacity`ff4?4?_6/k_ Type A/4- Material-_ ------ __- No. Compartments ' Distance to nearest: Well Y.�'r--------------------Fours tion -_�a---.___.:__ Prop. Line .-_!� -_.___-__ LEACHING LINENo. of Lines ---------------- Length of`each line----- �---------- Total Length _' .I..a 'D' Box ---,/---- Type Filter Material -A --_--Depth Filter Material ----JF-' ------------------------- Distance to nearest: Well _. fJ__,-_ Foundation _----/,a-- -_.___ Property Line ---S_______________ SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number --------------------------- Rock' Filled Yes ❑ No i❑ Water Table Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well -.-------------------------_------------Foundation --------------------- Prop. Line _ --------------- REPAIR/ADDITION{Prev. Sanitation Permit# ___________________________________________ Date _______________..-__._____________) .. . Septic Tank (Specify Requirements) - ----------------- -------------------------------------- - L 9 ----------- f- } Disposal Field (Specify Requirements) ---------------------------•------- ---------------------------- -------- ----------------------------------- - •. ------------------------------------------------------------------------------------------------------------------------- _..----------------------- ---__}-_______----_ ------------------.------------------------ --------------..._-._-.---.-----------_____________---------.------__-___-__-__----___------__--_--___-----_________---__-.----_---------_-.-----__.____-----_y-----------------_--_____--_-_-_----_-.__--- i_ J {Draw existing and required addition on reverse side) i{ 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin d County Ordinances, State Laws, and Rales 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 Workman's Compensation laws of California." Signed --------------j---- ------ --------------- ---- - Owner"'Y ------ Title ---- -- B ( other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - . ---- --------------- ---------------------------------- DATE . ` - -•--------- BUILDING PERMIT ISSUED ---- -------------------------------------------------------------------------------------=--------------DATE ---- -------- ------ ADDITIONAL COMMENTS ----------------------------------------------- - ----- --------------- .--------------------------------------------------------------------------------- ----------- - ----- ------------------------------------------------------------- --------------------------------------'---------- ----------------------------- -- -------------------------------- -- --------------------------------------------------------------- ------ Final,Inspection by: ------ Date SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. SM I