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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. 7k�Y6 - ---------------=--------------- P ._ {Complete in Triplicate) P Date Issued _ ------------------------------ -----------_----_-------- This Permit Expires 1 Year From Date Issued 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: ------ --------CENSUS TRACT .-- --------•------- JOB ADDRESS/LOCATION �ef' ��---� :-�--- -----�--f------------=- `'� - -- Owner's Name ----- ----------------------- -------------------Phone ------------------------------------ Address ---- - - --- - ----- ----- City --------------------------------------------------- Contractor's Name ---- -- - -- ----- - ------ --------License # -� _ _ Phone Installation will serve: Resid nce Apartment House❑ Commercial ❑Trailer Court ;❑ i II ,Motel E]Other - ---------------------------------------- Number of living units:------1-_--- Number of bedrooms _�K---Garbage Grinder ------------ Lot Size -___________________________________________ Water Supply: Public System and name -------------------------------•----------------------------------------------------------•------------------.Private t Character of soil to a depth of 3 feet. Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam f-I Clay Loam }} 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,) Q PACKAGE TREATMENT [ SEPTIC TANK'[ ] Size-----------------------------------•------------ Liquid Depth ----------------_--------- `- -Capacity ---------..= Type-------------------- Material---------------------- No. Compartments ------•----------- Distance to nearest: Well ------------------------------------Foundation ------ --------------- Prop. Line -------------_-------- LEACHING LINE [ ] No. of Lines __.--------------------- Length of each line---------------------------- Total Length _______-________. -.-------- { 'D' Box -------------Type Filter Material ____________________Depth Filter Material --------------------------------------- Distance _________-_____----Distance to nearest: Well _________________ _____ Foundation -------------.---------- Property Line ---------.___-_---._..-. SEEPAGE PIT [ ] Depth ______ __________ Diameter ------------- -- Number ---------------------------- Rock Filled Yes ❑ No i❑ _ f WaterTable Depth --------------------------------------- --------Rock Size -------------------------------- _ Distance to nearest: Well --------- -------------------------------Foundation ____ Prop. Line -----------_______ REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------1 `�^ v� Septic Tank (Specify Requirements) ______________________ _ __ ' ---- -----------Disposal Field (Specify Requirements) • y r ddh - &- ------ Jfi' s------------------------------------------------------------------------- ------------------------------------------------------------------------------- ------------ (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 Workman's Compensation laws of California." Signed - ---- --------------- - --- ---------- ---- Owner . „ . By ------ -------------------------------------- -- Title -. (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY __ - DATE -__-__' _____.7 ------------------ BUILDING PERMIT ISSUED ----------------- ------------------------------------- --------- ------------------------ --------DATE ------•------------------------ - ADDITIONAL COMMENTS ------ ---------------------- -- --------------------------------------------------------------------- ------------ - - -- ---------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- - - --- -------------------------------------------------------------- ----------------------------- - -------------- --------------------------- ---------- ------ - - Final Inspection by: ---- Date -/ :_.7� -=----------------------------------------------------------------- -- - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.