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FOR OFFICE USE- APPLICATION FOR SANITATION PERMIT ' Permit No. 7-�:-�•d--9- -- - (Complete in Triplicate -- ------ Date Issued " This Permit Expires 1 Year From Date issue - -------------------- 4 etoaheJoaquin Local Health District for a permit to construct and install the work herein Application is hereby mad described_ This application is ma -Sbri compliance with County Ordinance No. 549 and existing Rules and Regulations: I } ---- ----------- JOB _ _ � -- - - -----CEN US TRACT -------------- JOB ADDRESS/LOCATION -----�-��-_. �.__�'�/-- - f -p----- Phone �� — a�[� 7 Owner's Name _.__ ----- --L--'------- -� �_ ;. f . City 3 Address -----------�1 Contractor's Name --------------------- ---- -- !-.License # Phone Installation will serve: Residence Apartment Houser Commerciol:❑Trailer Court ❑� Motel ❑Other -------------------------------------------- F ---------------- Number of living units-----]------ Number of bedrooms __5______Garbage)Grinder ------------ Lot Size ________________ - Private --------------------------- Water Supply: Public System and name ------ ---- -------------------------------------- Character ------------------•-- -Character of soil to a depth of 3 feet: Sand'E] Silt❑ Clay ❑ Peat ❑ Sandy Loam ,El Clay Loam F1 Hardpan ❑ Adobe` Fill Materials_--- ------ If yes,type --- ------------------------ { ' ` (PPot plan, showing size of lot, location of system insrelation-toells, buildings, etc. must be placed on reverse side' �µ NEW INSTALLATION: (No septic tank or seepage pit Permitted.•if-public-sewer is available within 200 feet,] � --------------------------------- PACKAGE Liquid Depth ----------•------•--------- Size _______. . TREATMENT SEPTIC TANK.1 ] e_ p Capacity -------------------- Type ----------- Mafieriai____----=}.--=--- No. Compartments Distance to nearest. Well ------------------------------------Foundation ---------------------- Prop. Line -------.---------• G ----------------------- Length of each line ----------- ----- ------ Total Length ----------- -------•--••--•- LEACHING LINE [ ] No. of Lines "-- 'D' Box Type Filter Material --------------------Depth Filter Material -------------------••--- ------------ Distance to nearest: Well ______---�-:__--�•-�Fovndation�_�:-�--=-------------- Property Line ______________ _ --•-•--- Depth Diameter' ---------------- Number -----------------'----------- Rock Filled Yes ❑ No i SEEPAGE PIT [ ) P ��---. --°----'-"' !ft Water Table Depth -- ---- Rock Size ---- ----------� l Foundation __-°_ Prop. Line --------- ---------- Distance to nearest: We ____- -�------•---------- --- - ------------------t Date -------------;------------------- ] jt _REPAIR/ADDITION(Prev. Sanitation Permit# ____ .- —.� �''�. --___F _______________ _ -____________-____• saw. 1 Septic Tank (Specify Requirements) - -- ------------------- -- �n ,t -- - -• ---------- �1 -----------' ------•-- -- --------------- Disposal Field (Specify Requirements) , �r �.� - ----- -------------------- ---------------------- -------------------------------------------------------- �. (Draw existing and required addition on reverseside, I hereby certify that I have prepared this application and n Joaquin and that the work will be done in accordance with Son er or licen- County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home own sed agents signature certifies the following: a "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 -------4(jil ------ ' Owner ----------------- Title .-: --------- ------ ------------------ ------ - ------- ------------ er t owner)! FOR..DEPARTMENT_USE-ONLY_ ---------------------- �_�_ __ _-w __._ .__•_ �_, ` APPLICATION ACCEPTED BY DATE + ----------- - =F = - r. . -- i�: � , -- -- DATE BUILDING PERMIT ISSUED _t_ ----------- ADDITIONAL COMMENTS ___-- ------------ --------- -•------ - ----------------------------- -- ------------------------------------------------ -------------- $ ---------- ---------------------------------- --- Date _... y - ---- --- -------------------- ------ ----------------------- --------------------- ------------ ------------- Final Inspection b - -------- - - - ---- -- - - ---------------- -- - - SAN JOAQUIN LOCAL HEALTH DISTRICT C � E. H. 9 1-'68 Rev. 5M r-