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,. FOR OFFICE USE: PLICATION FOR SANITATION PERM'S --- ---- ---- - ---- ---- ---- - ------ ____ 1Permit No. 7 (Complete in Triplicate) ------------_-------- This Permit Expires I 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 camp 'ante with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/1_01 I _ ----- CENSUS TRACT __._�_5- --.__ - ----- ___-------- PhoneOwner's Nam l� + ._.. Address \ r4 -- 1 Contractor's Name �� ---- "-----.License # ASV7—i---- Phone .E1 - c 2� Installation will serve: Residence ❑ Apartment House°❑ Commercial ❑Trailer Court // Motel ❑Other - ---- ------ ---- ----------------------- Number of living units:____ .__ Number of bedrooms ------------Garbage Grinder ------------ Lot Size _. _ ________.__ Water Supply: Public System and name ------------------------------------ -------------------------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand'❑ Si It Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe Fill Material ----- ------ If yes, type -_-- ------ - (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 TREATMENT [ ] SEPTIC TANK'[ ] Size------------------------------------------------ Liquid Depth ___.____._.____._______-- Capacity -------------------- Type -------------------- Material---------------------- No. Compartments -----------•----------- Distance to nearest: Well ____________________________________Foundation ---------------------- Prop. Line ______________________ ti LEACHING LINE [ ] No. of Lines ________________________ Length of each line---------------------------- Total Length ---------------------------- 'D' Box ____________ Type Filter Material ____________________Depth Filter Material _____________ 9 ------------------------------- Distance to nearest: Well ---_------_------------- Foundation _-- ----- Property Line _________________--_.___ SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number -- --- Rock Filled Yes ❑ No Water Table Depth ----------------------------- ------------------Rock Size ------------- ---------- ------- Distance to nearest: Well ________________________________________Foundation -------------------_ Prop. Line ---------.________---- REPAIR./ADDITION(Prev. Sanitation Permit# ___________________________________________ Date ----------------------------------) Septic Tank (Specify Requirements) ---------------------- - ------------------- --,..---------------------------- Disposal Fi Id (Specify Requirements) -------- - -_- f-"-- �_ -_-- f ----- ----- a7 S --- - ----- A_--------------------------------------------------. - _____._- _ -.____________._______-_____ ._________...___.____.__.._ _____-____.___________________.____ ___________________________________ (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 beco esu ject to W rkm 's Compensantion_ laws of California." Signed ------------------ Owner BY -- i"a �� ---------------------------- Title - --- --- (If other than owner( rR ARTMENT USE ONLY APPLICATION ACCEPTED BY ---- --- ---- ------------------------------------------------------ DATE ----- / ------- BUILDING PERMIT ISSUED --- ---- ------ - - -- ---- ------ -- DATE ------------------------------------------- ADDITIONAL COMMENTS ------- - - - ------ -- -------- ------------ ------ ---------------------------------- -- ----------------------------------------- --- --------- -- ----------------------------------------- -------- ------------------------------------------------------------------------------- ------------------- ---------- ---- ----- ------------------------------------------------------------------ -----------------------------------------=------- Final Inspection by: ------ ---- -- -- ---- ------ -- Date - ../d-� JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 ev. M