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FOR. OFFICE USE. APPLICATION FOR SANITATION PERMIT ' ;. ............................. ............................ (Complete in Triplicate) Permit No. ...7 r./14 ------ - ............ sued sued ........-.......... # This Permit Ex pi res 1 Year From Data 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 tend Regulations: .JOB ADDRESS/LOCATION 7.,��1l�✓'`-�.. .. .. .. . ....��>-u��._...__#:.:` ..,---.. . ._..._..........CENSUS TRACT .......:.... ...... ,L[ 0A_ - , Owner's Name .. ....J .. ` ' •.....- • Phonea , ... l.Yi�.. Address - . ........ --•--•... ---- .__.... _ . _. .. City --�_ cam..........................................Contractor's Name ..._ _ License# Phone 1<52`.yl� ,•, Installation will serve: Residence [$Apartment House O Commercial OTroiler Court 0 Motel []Other ......... ......... ---------------------- Number of living units:...1...... Number of bedrooms -.-` Garbage Grinder ............ Lot Size ... r Water Supply_: Public Sym ste -and-name _.__ / - ! Private ---------------- —..._....... Pri to Charocte-r of soil to a depth of 3 feet: Sand .-Silt❑ -Clay [] Peat❑ Sandy Loam ❑ Clay Loam ❑ [ Hardpan ❑ Adobe ❑ Fill Material ............ if yes,type -------J----------- - � L (Plot plan, showing size of lot, loication of. system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: I(No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK i - Liquid Depth _..-•---••--••-- S ] Size....•..... ------ . ... _ Nol. Compartments ._z.............. 3 Distance to nearest: WeN /.��s....E �YFoundation .._._fa Prop. line _._ ....... LEACHING LINE [ ] No. of Lines "" ' i . '"` ---------------- Length of each line---,1 t .................. Total Length ...-• -- ......... �` l ! Type Filter ll/lateria#W`} � _ 'p 0 Filter Material ............ • Distance to nearest: Well ...__---•............... Foundation . ..................... Property Line ......... � SEEPAGE PIT Depth ----------.•-•_-._-- Diameter ---------------- Number __.....------.._..__........ Rock Filled Yes Q No.Q Water Table Depth Rock Size ` F f P ....................... ----•..................._....... Distance to nearest: Well ---------------------...................Foundation .................... Prop. Line....................... REPAIR/ADDITION(Prev. Sanitation Permit# _.........._-------------------------------- Date .................................. f Septic Tank (Specify Requirements) .......................-------------••----------------.............................___ Disposal Field (Specify Requirements) ...................... ...........•-.--......---._...----------• .................... ...................... ._....... I _----• ----•-•------- -----..._. . -.------•-•-......•....._..__...._...._...........................__........... •...... - (Draw existing and required addition on'reverse side) a 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 ..._.._.r.. .. ••-------•- - ..`---- • • . ......... Owner By --------------- Title ................ ................. (if other than owner) Y. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ... ;.._ ............................:..•------..._----.......-•--•-•-••--•...--•-.. DATE .. $" BUILDING PERMIT ISSUED .._. - - - ---•------••--------- ------------•........................•---------:................------....--•-=----------....DATE ........ ....... IF ADDITIONAL COMMENTS ...................................... .....•- - ........................... ..................................................................................................................I................ + .........._____..._..__ •_...._........__.._-_...._....... ................................. .. ....... ••• ...........................•___............._...._..........___.._......_..........._..........._ __••••__- Final Inspection by: .. ............:.... Date SAN JOAQUIN LOCAL HEALTH DISTRICT 1 E. H. - 13 24 '68 Rev_ 5M