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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT - Permit No: 7-�------------ --- ----- ~---------------- ---------- ---- s -`-�----- ----------- (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: y CENSUS TRACT ---------- --- ----- JOB ADDRESS/LOCATION - 4 -�_l_/- 11-- l2 =j / Phone __ - 7--- Owner's Name ' -C 'C, C ✓ �/ ------------------- --- Address -------f �3_3----------- - ----- : 49XV4------------------------------- - City -------------- - Contractor's Name --.___-. __LN_ ---�---�----- ------------------------------------------- ------.License # ------- ---------------- Phone ----- --- Installation will serve: Residence' Apartment House'❑ Commercial []Trailer Court ❑ Motel ❑Other ---------------------------------------- -- Number of living units:_.__--�__-- Number of bedrooms _---_ _Garbage Grinder ------------ Lot Size ---_._----------- ---------- ___ ---•---------------- ------------------------Private Water Supply: Public System and name ------------- -------•------------------------------ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ ~ Clay Loam ❑ Hardpan ❑ AclobeX Fill Material --------- -- if yes, type ---------------------------- (Pl'ot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) V NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) ` SEPTIC TANK Size_--. - Liquid Depth ----5- ---__---- PACKAGE TREATMENT [ Z_ Type _Pw Material__ No. Compartments ----'Z- -�- TANK. -- / r --------------Foundation ...------------ Prop. Line -_.r------------ Distance to nearest: Well -_-_ ------------ f q ---- Total Length _- '------ LEACHING LINE [�No. of Lines -- ----------------- Length of each +line.---- / - ---- gni ter Material 'D' Box - ---- Type Filter Material _1Z_Z�r-Depth Fil _19--------------- r 1 1 �_ Pro e Line - ---------- Distance to nearest: Well -_ -- ------- Foundation __-------- P rtY SEEPAGE PIT [ ] Depth ----V--_--- ------ Diameter ----------- ------- Rock Filled Yes No ' ----- Number ---- Water Table Depth ----------- -------------------- -Rock Size -------------------------------- -------------- Distance to nearest: Well -------------a__a---_-r.-.- •------•-Foundation -------------------- Prop. Line --- •--- -------- f n Permit# Date _ -= Se fiic Tank (S ecif Re uireme REPAIR/ADDITION(Prev. Sanitation nts) ---------- ---------- --------------------------=------ - - -------------------------- ----------------------- Disposal Field (Specify Requirements -------------------------------- --------- -- - -- ---------------------------------- - ----- -- ------------------------------------------ -- --- ----------------------------------- -------- ------------------ _ - ----------------------- ------------------=------------------- ---------------------------- i - (Draw existing and required addition on reverse si of--p` I hereby certify that I have prepared this application and. that the wo'rk�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 i the perfor nce of the'work for which this permit is issued, I shall not employ any person in such manner as to bec a .sect tow a ompensat's.on laws of California." Signed _ .. ---i----- Owner ----- - ---------------------------- ---------------- ------ -Title --------- --------- -- --------- - -------- ------------------------ - (If ath r t an owner) ARTMENT USE ONLY APPLICATION ACCEPTED BY _.-- -- ------- -------------------------------------- DATE ------------------- BUILDING PERMIT ISSUED ----- ------ - -- ----- - --- ------ - ----------------------------------------------------------DATE -- -- -- -------------------- ---------- ADD1TiONAL COMMENTS - ------------------------------- - ---------- ---- ------ -------- -- --- ------------------------------------ ----------------------------------------------- ---- --------------------------- --------------- ---------------- ---------------------------------- ,ter --- � ---- Date - -- - - ------- -------- Final Inspection by: :'-- -' - -- -------- - - - SAN JOAQUIN LOCAL HEALTH 61STRICT £� E. H. 9 1-'68 Rev. 5M