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FOR OFFICE USE: APPLICATION'FOR SANITATION PERMIT -----------------�---------------•-- Permit No: .7 Z--�_�__�<. Z (Complete in Triplicate) �/v� �lS/-------------- / _ _t________________________ This Permit Expires 1 Year From Date Issued 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 applicatioA is made in compliance ith County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION UN_ ___0._z__1___-- - _ f ____ -----------CENSUS TACT -------------- ----------- i G'G ,r/ _ " Phone='-Owner's Name Address -------------------------- --- ------- /�"- `--�---�----- --- - ( Contractor's Name - T--------- - - -------------- License �/ �- --- Phone Installation will serve: Residence ® artment House❑ Commercial []Trailer Court i❑ Motel ❑Other --,L . ------------------------ [ Number of living units:_.___-_ Number of bedrooms ___Z3_;__Garbage Grinder x� ___.__ Lot Size __�__L� ---IV-6 Water Supply: Public System and name ------------------------------ -------------------------- ------------------------------------Private Character f soil to a depth of 3 feet: Sand❑ Silt❑ Clay Peat❑ Sand Loam El Loam , '.';s a Hardpan ❑ Adobe Fill Material ,?IhI"f 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 TANKSize_____ __ _,�___ Liquid Depth ___ __. �p •� Capacity _�-:--- Typeio� �%Nlaterial o. Compartments -----�....... N SS�b Distance to nearest: Well _./� ___________l`Y4b"_----____Foundation ............ Prop. Line ... LEACHING LINE No14 . of Lines ---r ----------- Len th of each line._ __ _ _ Q ' g -_� _ � _____ Total Length .................. D' Bax __ __.__40__._ Type Filter Material _____C�_____-Depth Filter Material .. _________________ _________ ___ Distance to nearest: Well _______ Foundation _ _ _________ Property Line -__J SEEPAGE PIT [ Depth ------- Diameter ;.3_ _ Number --------------------------- Rock Filled YNo i❑ . Water Table Depth ----------- ---------------------------------Rock Size --- �------------ Distance to nearest: Well ________ _ ____________________Foundation _ --------- Prop. Line . ..... REPAIR/ADDITION(Prev. Sanitation Permit# __..___._______________--------------------- Date ________-__________----_---_---__} ' � Septic Tank {Specify Requirements) -------- ----------- ---------------------------_-----------------•---------------------------•. i-----------•----------- _. Disposal Field (Specify Requirements) - - ------------------------------------------------------------------- --------- ---------------- -------------------------------------- ---- -----------------I-------------------------------- _ (Draw existing and required,addition on reverse side) I hereby certify that-1`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 ----------------------- -- ----- 'lJ__- _ { -------- --------------- Title ... -- -- ..... (if; e�than owner) � �� FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------------- i-A-------------------- - --------------------------------------------------- DATE ----- -------------- BUILDING PERMIT ISSUED ------------- -------------------------------------------------- --------------------------- DATE ------- -------------------------------- ADDITIONAL COMMENTS ________-_"_._ r f F _____________________________________________ ____ -------------------------------------- --------------- ____________________________________ ________________ ________________________________________________________________________________ ___ _____________________________________ ___ _ _ _ _ ______________ ___ _______________________________.__ _._______.___ _______ _ Final Inspection by:,,,, --- y-_- -------.Date -------- ------- ------- -- - -- . SAN JOAQU • LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M ° Y-�_ Y