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FOR-OFFICE USE: APPLICATION FOR SANITATION PERMIT ------- ------------------------- ------------ Ppmpleie in Triplicate} Permit No. -7 _--- _-----. This Permit Expires 1 Year From Date Issued Date Issued -7 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: i JOB ADDRESS/LOCATION ---------- .�----- ---1 i C% -------_ --------------------------CENSUS TRACT Owner's Name - �1__�1 Phone 2 � ------- Address ------------------------------ ----------------------------------------------- . City -r� -'-�.�'G�------------------------------------------------ Contractor's Name ------------- — --------------- ---------------.License # ------------------------ Phone -------------------- Installation will serve: Residence ❑ Apartment House /❑ Commercial :.F-)Trailer Court C]Motel ther ---_TG�•=7cr)---------------------- Number of living units:----t------ Number of bedrooms --'T-------Garbage Grinder ------------ Lot Size ----_-__---ZC�-�G - ----------------------- Water Supply:,PbG is System and name -- -----------------------------------------------------------------------------------------------------------Private [ Character of_soil to a depth of 3 feet: Sand'[--! Silt C] Clay ❑ Peat❑ Sandy Loam •❑ Clay_Loam :❑ - ,o M------'Hardpan ❑ Adobe ❑ Fill Material ------------ If yes,-type ---------------------------- (Plot _-- _-_-___-_- -- ___-_(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 seepcialB pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT { ] SEPTIC TANK'[ Size------------------------------------------------- Liquid Depth ---------------------.-••-• r I Capacity e-- No. Compartments -----�-------:---- NUTYpe � -_- Material-�s�a Distance OQ to nearest: Well -" �/-------------------- - Foundation ---------------------- Prop. Line -_------_----:-.-_--__ (iNo. of Lines -----1---------------- Length of each line--- �''f(�1----- Total Length ,- ..Y. 4....-....__ to Type ✓ -_Depth Filter Material , 'D' Box��----- T e Filter Material ------------- -----Z,5?'"-----•...........---------- SDistance to nearest: Well __----- _ Foundation ------------------------ Property Line ........................ SEEPAGE PIT [ ] ' Depth -------------------- Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No i❑ s �—Water Table Depth --------------------------- ----------------Rock Size -------------------------------- f Distance fo nearest: Well ---------------------------------- --Foundation -_-----_------------- Prop. Line .............:........ E REPAIR/ADDITION(Prev�Sanitation Permit# -------------------------------------------- Date ------------------.......-........ ] SepticTank (Specify Requirements) ---------------------------------------------------------------------------------------------------------------' -------------------------- Disposal Field (Specify Requirements) ----------- ----------------------------------------------------------------------------------------------------- n -------------------------- - i;.[Draw existing and required addition on reverse side} E I hereby certify that I have prepared Qs 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 p.erformdnce of the work for which this permit is issued,I shall not employ any person in such manner as to become subject to V11ork�man's-Compensation laws of California." Signed { -L ------------------ Owner -: Title BY _ - (If other than owner) ;..� FOR'DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .............. j }-------------------------------------------------------- DATE '7 !r- -• BUILDING .PERMI.T ISSUED -------------------------------! _ _-'--- ---- .-.-- : _r_DATE ,----_----------------------------------- ADDITIONALCOMMENTS --------- ----------- ------------------------------------ --------- --------------------------------------------------- --------------------------- dKo • - - - ---------- ------- Final Inspection by: - � �w - --------- �� ----.Date ----------------------------------------- - SAN JOAQUIN LOCAL HEALTH DISTRICT ' 2AMM�_.9_ E. H: 9 1-'68 Rev. 5M