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!I f FOR OFFICE USE: !' �i APPLICATION FOR SANITATION PERMIT '! ---------------------I--------- ---------------- ------------- ----- Permit No:7j `7_ .- i� (Complete in Triplicate) t , ----------- -----------------------------------------=-- Date Issued S_� "r_______________ ____ This Permit Expires 1 Year From bate 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: ! . . ' ----CENSUS T RACT f[ JOB ADDRESS/LOCATION ------ ` -----------------------------------------Owner phone , _ Address ---- =_--------- ------ ----------- City ------ ........ I ` Cont actor's Name - ------------License #� �------ Phone 1 Installation will serve:' Residence 19 Apartment House,❑ Commercial:❑Trailer Court !❑ Motel ❑ Other --------------------------------------- -- 04 Number of living units:--:;0__ Number of bedrooms.----Garbage Grinder----------.... Lot Size __ ___________-------_---------------- Water Su ; II � t I ppY� Public System and name _ - ------------------- ----•--�--------------------- ---------•---•-------------•---------------------Privat Character of soil to a depth of33 feet: Sand'❑ Silt E] Clay [-] Peat❑ Sandy Loam -E] Clay Loa 'l Hardpan ❑ Adobe❑ Fill Material ------------ If yes,type __------------------------- I v (Plot plan, showing size of lot, location of system in relation to wells,i?uildings,}etc. must be placed on reverse tside.) v NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) p PACKAGE TREA7MEN5 i - T { ]j SEPTIC TANK'[ ] Size -----•E---------- Liquid Depth --------- ------------•--- ` Capacity ------------------- Type ----------------- Material------------- -----t No. Compartments -----�----- _ 1 « Distancelto nearest.iWell ___ ________________________________Foundation :--------------------- Prop. Line ----- LEACHING LINE, [ ]4 No. of Lines --------- � 11-ength of each line------------------- -------- Total Length --------- --------------- : r I f 'D', Box ---------- TypefFilter Material --------------------Depth Filter' Material --------------------------- Distance to nearest: We11 .._.I------------------ Foundation _--_-____-_,----------- Property Line - _ _ _ _ SEEPAGE PIT []] Depth. �.__ ------ __€ Diameter ________________ Number ---------------- ---------- Rock Filled Yes ❑ No 0 Water Tablo' Depth f-------- I----I—A------------------- ------------Rock,Size --- ----------------------•---- r� i k Dis _ ion !------------------- Prop. Line ---•-- ..�..... REPAIR/ADDITION(Prey. Sa ante to nearest: Well �_____-__ - -- - - Founda# ; nitation Permit# -------------------------------------------- 17ate _ _ : ---------'•-----------------1 1 : F SepticTank {specify Requirements) ----------;---'--•----------------- - --------------------------- ---- -----------------.---------- -------•----------------------------- D ------------ Disposal Field (Specify Requirements) ,t._ _ ! r ----- --------- -�--- - --- ------------------------- ----------------------------------------- l , {Draw existing an(i:required addition on reverse side) r I hereby certify'that I have prepared this application and that the work. will be done in accordance with San 'Ja gain County Ordinances, State Laws, and Rules and Regulations of the. San'Joaquin Local Health District. Home owner oricen- sed agents signature+lcertifies 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 su�ject fo Workman's Compensation laws of California." l Signed I BY ---------=---�-_---,--- Owner Title -- �,--- l ----- (If other than owner) 1 FOR DEPARTMENT USE ONLY ` • ' APPLICATION ACCEPTED BY �-C e._t ----------------------------------------------------------. DATE _. � w -------- -------- _ 7_- BUILDINGPERMIT ISSUED --------------------------------------------------------------- --------------------------=--------------DATE ----------------- ---------------------- ADDITIONALCOMMENTS -- ------------------------------------=----------------------- -------------------------------------- ------ -------------------- -------------------¢h¢-------- ----------_______-----------------______________________--------__________-______-____-_____.______.__-____-__.-____-_____..--------------------------------------__-------------------E.____.-1-------- --------------______________________________ _______________ _________________________.._-_.--------__.____________._-_-___.__.-_--____-____________.---_-----__-_____-_______-._-_______�---____l - - / L - -7 f , FinalInspection by: - -------------- ------------- ---------------------------------------------Date ----- 1------------- i I !I SAN JOAQUIN LOCAL HEALTH DISTRICT 4 E. H. 9 1-'68 Rev. 5M } t