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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT p $• a -1 l 'b7p1. Permit No. —7 __z�d. ------------------ ---- -- -------------------- (Complete in Triplicate) -- Date Issued _ ._.'.'_'____. _---------------• This Permit Expires I 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: JOB ADDRESS/LOCAT N .--- /_-J v----- •-e_- -- ---- - - -- -rG '�✓ L (_CENSUS TRACT -------------- ----------- - --------- - Owner's Name .__ - - -- ---- Phone _ �S-- �� ------ Owner's --------------------- -- - --------------------- --- Address/o---��---- ------- - -- - -- -� ------------------------------------------------- CitY -- ----- --------------- -- ----•- -------------------------------------•---- Contractor's Name -- ------------ ----- -- -- ---- �(7t.� License #l( .Sl, ---- Phone q�-6-�-r--��7--- Installation will serve: Residence AApartment Ho se,❑ Commercial ❑Trailer Court :0 Motel+❑ Other ------ - -- ---------- ------------ -- Number of living units:----/------ Number of bedrooms ________"Garbage Grinder ------------ Lot Size 3-------------- Water Supply: Public System and name -------------------------------------------------- -----------------------------------------------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ 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,) � `/' �r- PACKAGE TREATMENT { ] SEPTIC TANK)4 S7iizze--_____ 7._X---Z_ ______________________ Liquid Depth ___�_ .____.______.. Capaci#y `t`V Type _615� ---------Material___ --• No. Compartments _-�"-•...�--- • ' . Distance to nearest: Well _____ --- d___"f _____________Foundation _----lQ-"------- Prop. Line ___�-. ------- -- tr LEACHING LINE No. of Lines -------- _________ Length of each line-----J- -------------- Total Length __.._____..R. r� D' Box __.__Type Filter Material _I ___________ p De th Filter Material ____l _----------__--------__.......... Distance to nearest: Well ____.r��-r-f_____ Foundation -----��_� --- Property Line _--.�__._-----_--- SEEPAGE PIT Depth _--- Zs----- Diameter __, "___ Number _.__-_-7.1-1 --�� Filled Yes �y No s0 Water Table Depth ---------------------------11 Rock Size 1��__r�-yProp. Line �� y� Distance to nearest: Well -------l�------------------------Foundation REPAIR/ADDITION(Prev. Sanitation Permit# _______.----------------------s------- ---- Date ----------------------------------I 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, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ------ ----- ------------- ----- ----------------------------------------- Owner BY -------------�`-� r Title -- ---------------------------------- (If oth r han owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------°-------------- -------------------. DATE TE . _ ------------------- BUILDING PERMIT ISSUED __ k-- --- DATE A ITIONAL CO M NTS Q 1'1� _ .- __ _--_--------- --,�---- ----------------------- ---------- _-_-_ _ ._ __ _ __ __ ._: : : :--_------------------.__��_.:__:__ __ _ ___ _ __ _ ____________r Final Inspection bY: -------- ------------------------------------------------------- ---------------- Date ---- �-/- ----------------- -Ir SAN JOAQUIN LOCAL HEALTH DISTRICT _ E. H. 9 1-'68 Rev. 5M