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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. 7�_�i d_b _ (Complete in Triplicate) -------------------- -------------------------------- --------------------------------------------------------- This Permit Expires 1 Year From Date Issued Date Issued 1 3! --3&0 --, 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 ADDRESSlLOCATION A4?rr4%_.P-v ----?e�a✓ � QT• . s�' 'Q�✓ _CENSUS TRACT __________________________ Owner's Name 1------------------------------------------------------------ -------Phone ------------------------------------ Address —6.7-1.6-7--- ------------- City Contractor's Name ----------------------License # PhoneG�c�. _ Installation will serve: Residence ❑ Apartment House❑ Commercial ❑Trailer Court ;❑ Motel ❑ Other �____=_ f Number of living units:---1__----- Number of bedrooms ___________Garbage Grinder ___________ Lot Size Water Supply: Public System and name (- / Private Character of soil to a depth of 3 feet: Sand❑ Silt F] Clay E] Peau Sandy Loam ❑ Clay Loam E]Hardpan E] Adobe E] 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,) PACKAGE TREATMENT [ SEPTIC TANK [ ] Size_______Z_X-__7------------------------- Liquid Depth ._:7- --______________ Capacity ____ Type Material_6. 69696-•- No, Compartments ---.?,. Distance to nearest: Well ------,;f-----------------------Foundation 1_0--------------- Prop. Line _.--S^............. , LEACHING LINE [ ] No. of Lines ____/_______________ Length of each line_��____.____.__.___ Total Length __.._.._.___.. 'IV ' 'D' Box�ii?__ Type Filter Material _/_.�X__�f____Depth Filter Material ----- ___________________`......__-_ ' Distance to nearest: Well __. ___!_________ Foundation __,/0-- -----_ Property Line -- _____________ SEEPAGE PIT Depth -- Diameter Number ____________________________ Rock Filled Yes No Water Table Depth ------------------------------------------------Rock Size -------------------------------- , Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ----------------..---- �• REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------1 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 'a 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 becoo Workman's Compensation laws of California., Signed -- - ---------- Owner By -------- - �_ i Title = (If other than o r) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --- 734� - --------------------------------------------- DATE r,~ ---------- f BUILDING PERMIT ISSUED -------------- --------_------DATE ----------------------------- -- - ADDITIONALCOMMENTS ---------------------------------------------------------------------------------------------------------------- -------------------------------------- ----------------------------- ---------------- Z--------------------------------------------------------------------------------------------------------------------------------- 21 ----------------------------------- ------ ------------------------------------------------------------------------------- ----------------- ---- - -------------•------ 12� Final Inspection by: -- ._Date ��.". -.7-------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M h 1