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`7 y (J. ver - : FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. .".7-)`�� ------------------------------------------ --------------- (Complete in Triplicate) t ------------ -------- --------------------------------- � 7Y . Date Issued .,�'"--�------•--. ---------------------- -------------- ------------ -- This Permit Expires f 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 madein compliance with County Ordinance No. 549 and existing Rules and Reg�uuJlations: �f -----------CENSUS TRACT _S_--I-.1-------------- JOB ADDRESS/LOCATION o _ �. ------ �J---- ' 11� J `� " "" --------Phone ----------------- Owner's Name = �cCp. CI ------------------------- -------------- -------------- Address ---- ---------- ----- __ N / ----- - -------------- ----- ------ - ---- ---- city -_- �- �t a-„1`.�`. License # _r.�'�--------r Phone ---------------- Contractor's Name -------- �1"U`�"'� `------- F -- ------ -- i Installation will'serve: Residence Ppartment House-E] Commercial❑Trailer Court ',❑ Motel ❑ Other ------------------------------------------- INumber of living units:-----!-_____ Number of bedrooms ___________Garbage Grinder ---------- Lot Size -------------------------------------------- Water Supply: Public System and name -------------- ---------------•---------------------------------------------------------------------------- Private R Character of soil to a depth of 3 feet, Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam .� Clay Loam;❑ ` Hardpan ❑ Adobe'❑ Fill Material ------------ If yes,type ---------------------------- .i W � (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) a Y NEW]INSTALLATION: {No septic tank or seepage pit permitte +� ublic-sewer is available within 200 feet,) � s � 1. .C' /__. r PACKAGE TREATMENT [ ] SEPTIC TANK'[ U Size 7v`:, --- r Liquid Depth _--/----------- Capacity ( Typ �� _ _ '-- 'No. Q " /1�-�G_ _ '_ Material_ — Compartments ,�---- Foundation ____�p_.____-""_-- Prop. Line .._____��____.-..""-•.- Distance to near4t: Well _.-"--_- �� ----------==----- o LEASHING LINE [ No. of Lines -------- Length of each` line__.�r'-�--------------- Total Length ___�___:____.�_________ ; tr + 'D' Box ----1------- Type Filter Material ----= ---!_ - ---Depth Filter Material --------- -------------------r----•---- + ��--±-- Property Line. ----- ---------•--•-- Distance to nearest: Well ______ -"" __________ Foundation - ---- p ty SEEPAGE PIT [ } Depth -----?-------------- Diameter ---------------- Number --------------- Rock Filled Yes ❑ No 0 i Water Table Depth ------------ -------- --- =----Rock Size- -- Distance to I nearest: Well _____________________ ------ _Foundation -------------------- Prop. Line _...__________ ....... ------------ REPAIR/ADDITION(Prev. Sanitation!Permit# ------------------------------------------"--- Date --------.------------------------- Septic Tank (Specify Requirements) ------------------------------------------------------------------------ --------------------------------------------------------- - - --------------------------- Disposal Field (Specify Requirements) --.--------- -------------------------------------------------------------- - ---------------------------------------------------------------- ------------------------------------------------- - - -------- ---- -- - - - - - ------------ ---------- ----- ' (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: "I certify that in the performance of the work for which this permit is issued, II shall not employ any person in such manner as to become subject to Workman's Compensation laws of California.” Signed -------------------- I --------- Owner ------------------------- - Title Y ------------ -- - --------- ---- n---w- ------------ ------ -- (If other thaoner) 4 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED By . -- - -------------. DATE _ ___-`� •-` - ----•• - -- -- - - --------------------------------------------- f BUILDING PERMIT ISSUED ------------------------------------------------------------------ DATE ADDITIONAL COMMENTS ------ --------------- -- ------------------------------------------ ---------------------------------- t ---------------------- ------------ ------------------------------------------------------------------------------------------------------ ------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------ ----- ------------------------------- --------------------------------te _� ------- Da Final Inspection by: __ a SAN JOAQUIN LOCAL HEALTH DISTRICT i E. H. 9. 1-'68 Rev:5M