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FOR OFFICE USE: - APPLICATION FOR SANITATION PERMIT -- --------------------------- (Complete in Triplicate) Permit No: 7 -------------------------------------------- 2— ;F 7D Date Issued -----_--------_--------------------------•----------- This Permit Expires 1 Year From 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: ► ., r ,��^cam. JOB,ADDR€SS/LOCATION —---------- �C-------::------- ---------- -- --- CENSUS TRACT -------------------------- '--------------------�--------------- -�Phone - - --- ' Owner's Name _...44�.-----��-�- ---��`T•------- --------------------=�="`-' --== Citt ---------------------------------------------- Contractor's Name- r ------------------t----License # ZA0._-S7-<1------ Phone'�vK7f2ko------- Installation will serve: Residence Aptmenf H`o'use -'Co--m ❑Trailer Cou t :❑ MotelM]Other -------------------------------------------- Number of livingunits:------1----- Number of bedrooms __Z-----Garbage Grinder Lot Size _.------------------------------------------ �� Water Supply: Public System and name �1_ileSF-1�-----•--•-------------------------- -------------------------------------------Private 0 Character of soil to a.c(e.pth of 3_feet; _$and Q, Silt❑ Clay .❑ '',.Peat ❑'9 Sandy Loam ❑ Clay Loam ❑ r { i Hardpan ❑ AdobeFill Material .___ If yes, type ---------------------------- ! � VI t (Plot plan, showing )size of lot, location of system in k 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 TANK'[ j____ 5ize___ 'r__� _ _��_______________________ Liquid Depth I Capacity -/ Oo--- - Type RCC,7-7---- Mater;)a1-09,Kee-r--___ No. Compartments ---- -.:-----___-- --- , — s ----_Foundation ------------- ------ Prop. Line ---------------- Distance to nearest: Well ��_ 01 LEACHING LINE [ ] No. of Lines ---- _-----------�ngth of—each line-__ __.-__.._____ Total Length _/J7P----_----------- s r i . *41 D' Box _3----- Type Filter Material 49277 __Depth Filter—Material ___14?________________________________ I Distance to nearest: Well ---------- Foundation __._-____-___.__.__-- - Property Line _________________ SEEPAGE PIT [ ] Depth ___a - #Diameter _ __ Number _-____.ate--------------- Rock Filled YesX No 0 Water Table Depth ----------------------------------------------Rock Size --------------------------- , Distance to nearest: Well _� �_________________________Foundation ------------------.._ Prop. Line ........._--_-------_. REPAIR/ADDITION(Prev. Sanitation Permit#t------------------------------------------- Date --------._--_____________--------_) 4 Septic Tank (Specify Requirements) ---- ------ -------------------------------- ------------------------------------ --------------------------------------------------------- Disposal Field (Specify Requirements) --------------- ---------------------------- -------------------------------------------------------------------------------------- t € _ _ _ _______ _ w (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 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 ' --------; Title (If other than owner) FOR DEPAR TffiENT L15 ONLY APPLICATION ACCEPTED. BY .-- DATE ADDITBUILDING PERMIT ISSUED ------------------------------------------------------------------ --------- - ------------ DATE IONAL COMMENTS ---------------------- ----- - --------------------- ---------------------------------------------------------------------------------------------- ------ ----------------------------- - --- ----------------------------------------------------------------------------------------------------------- ----------- - ---- Final Inspection by: = l Date _^y7_~_ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M