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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT p� (Complete in Triplicate) Permit No. -7 __'__l4_-X ------------------- ------------------------------------- This Permit Expires 1 Year From Date Issued 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: i r JOB ADDRESS/LOCAT ON ._.-(_-9 I W �- ---------A) ------ -- -1- - ---- ----------------------- -- ENSUS TRACT Owner's Name ' Q Phone .- -------- Address _-____..__.--_ -1 --- -- ----- - G Contractor's Name _--__ Installation will serve: Residence. artment Hduse❑ Commercial 5eai e�{_3 Phone ----_.---_---------------- d ❑ -ourt I❑ Motel ther ---------- .-_- Number of living units:- _1.-- Number of bedrooms __3------Garbage Grinder _---- ` Lot Size -----------------_--__ Water Supply. Public System and name ------------ ----------- --------- Character - - ------•--........................................ Private L� Character of soil to a depth of 3 feet: Sand' Silt❑ Clay ❑ Peat❑ Sandy Loam;❑ Clay Loom [] Hardpan ❑ Adobe ❑ Fill Mciterial ------------ If yes, type ------ (Pilot ---(Plot plan, showing size of lot, location of system Jn relation to wells, buildings, etc. must be placed on-revveerrse side.) NEW INSTALLATION: � (No septic tank or seepage pit,permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT ` t [ ] SEPTIC TANK [ ] ,Size _- Liquid Depth ---_ - -------------------------------------- ------ Capacity ----------------�---�- � Material---------------------. No. Compartments - ---------------------- N Distance nearest:. Well - ---^ti-�--E.a Foundation ---------------------- Prop. Line --=------------:------ g LEACHING LINE � � : j - [ ] No. offLines ------------------------ Length of each line---------------------- ---- Total Length --_----__---- •----- y D' Box ------------ Type Filter Material --------------------Depth Filter Material ----___x----------- ----------------•----- � Distance to nearest: Well -------------------I---- Foundation I [ ---------------- Property Line, ---- SEEPAGE'P1T [ ) Depth -------------------- Diameter ---------------- Number ------------:--------------- Rock Filled Yes;❑ No Wafter Table Depth Rock } Sizer----------------------- Distance to nearest: Well ---------------------_________________i;_Foundation _�--_---.-__ ' REPAIR/ADDITION(Prey. Sanitation Permit# --------- -•-------------- � --- i Prop. Line.- - ------t-- -.------ Date ------------ --------- ----------- Septi Tank (Specify Requirements) ----------------- ,� ------------------------ - - -- Disposal Field (Spec' y Requirere __ --------- �_� `- = ------ --------------------------------------------------- ------ - . 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: "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 W a Compensati ws of California." Signed ---__-- --------- -------- # ------- ---- ---Co__ -- --- ---- -- --- Owner ' - - - - ------ ------ BY - Title fif a#h r than owner) - -- -- -.. ------- ---------- -- FOR DEPARTMNT USE ONLY APPLICATION ACCEPTED By . BUILDING PERMIT ISSUED - - -------- - - ------- ---------- ----- DATE - •-=.l� -=-�-�'• ------------ ----------------------- ----------------- ------------ -DATE --------------------- - ------------------------------- - ITIONAL COMMENTS ---- ---------- -------- - - ------� - --- ----------------------------------------- -------------------------------- ------ ---------------------------------------- -- --------- -------- ------ ------- -------- --------- - --------------------- ----------------- --------------------------- --------------- ----- -- ` ---------------------------------------------------------------------------� _-t Final Inspection by: j__, ---- - --- -- ------ - ----- - -------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M