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FOR OFFICE USE: I APPLICATION FOR SANITATION PERMIT --------------------------------- ----------------------- Permit No: ..7? (Complete in Triplicate) ----------------------------- ------------------------=--- I } ----------------- j This Permit Expires 1 Year From Date Issued Date Issued - --6-:- --7! , Application is hereby mad,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/LOCATIO - ----/F--- _ - �' --------- -- - � /� "`.'"' --CENSUS TRACT -5- _-• ... Owner's Name �? `l f fTv ---------------------------Phone ------------------------------------ Address __" �-lV ---- � = F 7�'------- btY ------- -------------,-------------------------------------•--- ------------- Contracto r's Name ---------------------------------------------License `�f Installation,will serve: t Residence X Apartment House�❑ Commercial [-]Trailer Court ;❑ Motel ❑Other ------------------------------------------- • .. . s Number of'livingfunits:---_lire_._ Number of bedrooms --�-----Garbage Grinder JII�!-___ Lot Size �.j��-.t. --e�--------------_ Water Supply: Public System,and name ----------------------------------------------- - Private, . Character of soil to a depth--of 3;feet Sand';0Silt❑ Clay ,❑ Peat❑ Sandy Loam •❑ Clay Loam ❑ Hardpan-(]1 "Adobe'[:],, iji�IVi terial -AID___ If yes; type ---------------- (Plot plan, showing:,size of lot, location of. system in 'relation to wells, buildings, etc. must be placed on reverse side.) c NEW INSTAlLATION:t y\INo,eptic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC.TANK:[ ] Size----------------------- � `�-^^-- ----------------- - ---- Liquid Depth ---------------• .......... f " ti Cal. = :---:-- - Type ------ Material---------------------- No. Compartments --------------- D sta>ce too nearest: Well -------------------+,-------.---------Foundation ---------------------- Prop, Line ] ,of Lines LEACHING LINE p. � N ------------------------ Length of each.._line----------,------------ ------ Total Length --------------------- D -------- �„�. Box T e ' yp Filter Material --------- -_-Depth Filter Material ----_____--_ Distance to' nearest: Well ----------------------- - Foundation ------------ Property Line_____------ 4 _. --�cr.-_`�'-..__._ k- SEEPAGE PIT [ 1;a Depth :t -. .- --- Diameter - Number -----..- .__------ Rock Filled Yes ❑ No i❑ ' Water Table Depth -----------------------M-- = Rock Size i i Distance to nearest: Well ----------------------------------------Foundation -----•,Prop. Line .--------------- -•-- REPAIR/ADDITION'(Prev. Sanitation Permit# ----------------------------------- ----- Date ----------------------------------- Septic -----,-----}...-------------Septic Tank (Specify-Requirements) --- =_=- ��: - ------# ---------------------- .. ----------- ---------------- Disposal Field,.(Specify Requirements) h� i 7---,� lp .--_ ------------ ---------------------- •� _ --------- --------------------------`-�_----------- ----------- •--------- } - -- ---------------------------------------- x �x - -------------------------------------------------------------------------------------------------------=----------------------------------------------------------------------------------------- (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 r County Ordi'n'ances, 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_Cdylifornia." Signed --- - ------ ----- --- ------------------------------------ t . Owner BY - ---------------------' ------ - y �j Title .ek . [If er than owner} ---- ------------------------------- _ l FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY L _-- ---------------------------------- =---------------------- DATE ---1-3`--7 BUILDING PERMIT ISSUED ;------------A- ---- ---------------- ��------------•----------------=--_-----------DATE ---- ---------------- ADDITIONAL COMMENTS - ,w--.-- --- - ------------- -------------- ---------------- - ----------------------------------------------------------------------------- ----- - - --- -- -- -- q --------'----- ,i{- - --- ---- -- - --------.---.----------------- ------------------------------- ---------------------`-------------------- f} - ---- --- - I, Final Inspection -------------.-_------ - - - 4 --------------------------------Date ---- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 12 Rev. 5M