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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ----------------------------------------- Permit No: 7-z".Z�__L. ' {Complete in Triplicate} -------=---------------------------------------------- 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 application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .-__/- 1 --, -- ___ i_-__ --- --- --T - -CENSUS TRACT --------------___--------- Owner's Name -0-;n-0------- 1`El oda------------ -------------- -------Phone-*7-d � onf city -------------------------------- ------ ------------- ------- I Address ------ ----------- ---------- Contractor's Installation will serve: Residence PI-Apartment House ❑ Commercial ❑Trailer Court Ni❑"-- Motel ❑Other -------------------------------------------- Number of living units:________. Number of bedrooms ---___.r4' _Garbage,Grinder ------- __ Lot Size ----_��-r ---------- Water Supply: Public System and name ------------------ --------------------------------------------------------------------- --------------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay E] Peat❑ Sandy Loam 0 C rayl LoamEJ f Hardpan ❑ Adobe '❑ Fill Material ____________ If yes, type ------------ ------------I (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'TREATMENTf [ I SEPTIC TANK f I Size------------------------------------------------ Liquid Depth ---i--------------------- Capacity -------------------- ----------.-------_.Ca acifi Type _k__________________ Material----------------------- No. Compartments -"" Distance to nearest: Well --�____________________ _ ____ �Q nf f - -----------Foundation '----- -- --------- Prop. Line ------•--------•------ ' LEACHING11INE [ N6.,.-of Lines -----------1--------.-- Length of each line--------- f1_.. Total Length `_- � ... ...... Y k / 9 ! F _ D'�8ox ----1 ---- Type Filter Material `----- --------Depth Filter M%erial --------,-l- -? --------------------- - a Distance tornear V.—Well ------�Qy_ ___ Foundation __-_._/_ _______._ Property Lirie __i-- Q__ ______ SEE�EePtT [ ) Depth _ , `Diameter 41yf_1C> Number --------- ---_ ------------ Rock t=illed ryes E' No 0 « k Water Table Depth ------ Rock Size ------------ Distance 9 a ,. - -------- t / Distance to nearest: Well ---------- ____--------------Foundation --- Prop. Line ______ _____________ EPA1 ADDITI07V.(Prev. Sanitation Permit# --------.----- ----------------------------- Date -----------_ ---------------_-_--} Septic Tank (Specify Requirements) -------------'--------------------------------------------------- °--------------;------------- .-- ---------------------- Disposal Field (Specify Requirements) ------------------- ..... ------------------------------ ---- ------1 u �`------- /0'--- �. ------------------------------------ - -------------- ------------------- ------------------- ` ----------------- - dY/0------------------------------------- ---------------- ------------------' -------------------- `� ' (Draw xisting and required addition on reverse side) I hereby certify,.that,,,Le prepared this application and that the work will be done in accordance with'San Joaquin County Ordinances,-State Caws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents sighci-tore certifies the following: "I certify that in the performance -of the work for which this permi[Q issued, I shall iiot-employ any person in'such manner as to become subject to Workman's Compensation laws of Caiifornia." Signed Owner -------------------- -- F - - BY --- ---------- -------• Title ----- - --- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY = =----------------------------------- -----------------q�'=-= - -------- DATE �� ` BUILDING--PERMIT-ISSUED ---"'-"=-�--�-�""`-. _-'=="_"=`.w__.�_�_� __..___.� . . ="""",• ' ""`=:::._DATE � :._._- ---------------- -- - -- - ------------- ADDITIONALCOMMENTS - ----------------------------------------------------------- -------------------------------------------------- ------------- '-------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- f --------------------------------------------------------- -----I----------- _ N FinalIns ection b " `-------------------- Date ----3" -------------------------------- p Y: ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT k E. H. 9 1-'68 Rev. 5M