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FOR OFFICE USE: _ -APPLICATION FOR SANITATION PERMIT d_ 7Q--------- ��' ----- Permit No: . (Complete in Triplicate) - -----------_---- -------------------------_---------- This Permit Expires i! Year From Date Issued Date Issued Z-6-_70 .4 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/ _-�O _ - ---- ----- ---------------------CENSUS TRACT ----------- - ��-- - - Owner's Name 7T'LI r ---Phone -7- 577-- ---Phone 1------- ----------- --- -- - ----- ------------ ------------- F f cwt --------------------- -- ----------------- Address -------------- f.K " `` - = City " . Contractors Name ------ ------ ---� K"' -------License #�l-C7i� -r�------ Phone ---- Installation will serve Residence ❑ Apartment House ❑ Commercial XTrailer Court [I Motel ❑ Other - } ---------------------------------------- -- y Number of living units:---- ----- Number of bedrooms ----1-----.Garbage Grinder ---.-_____-_ LotiSize ----_/ -y--- -- _ _-- -- Water Supply: Public System and name -------------------- •-------------------------------- ---------------------- Private r2'�,� 1 - ' Charader of soil to a depth of 3 feet: Sand'❑ Silt❑ 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 -------------------------- !" 11_ 1 Capacity ------------- ------ Type ------------�--�Ma��terial----- ---- '''No JCompartments Distance to. nearest: Well __,Foundation ------ --------------- Prop. Line -_------.... -------- 9e LEACHING LINE [�] No. of Lines ----------------� --, ength of each line.__ .. _.________-------- Total Length `'D;yBox - -�--type FiLter�.Ma#er.iah-r---- Depth Filter Material ---------------------------------------• -• ? t f � Distance to nearest: Well _ ; "--.-----�-- Foundation !Property Line, ------------------------ ltW ' SEEPAGE PIT [ ] �hD pth __-- Diameter ---------------- Number -------.-------.-.------_-- Rock Filled Yes ❑ No ] Water Table Depth ------------------------------J -----------•--I-Rock Size ---- ----------•--- ii Distgn,ce�to nearest: Well ------------------ ---�--------------- '-Foundation ____.-------- ------ Prop. Line ----____---------__-- REPAIR/ADDITION(Prev. Litat Permit # _.-_---•--------------------- -------- ---- (Date ----------------------•_--'-------I Septic Tank (Specify Requirements) ------------------------ ----------- ! Disposal Field (Specify Requirements) ----- - -------------------- -- 1 ° ,tk ` - - 0-- ----- ------- --- --------------------------------- - �� - _ {Draw a sting 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 ofA a San Jo��in 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 ins issued, I shell not employ any person in such manner as to become subject to Workman's Compensation laws of California." 'I Signed ------------------------------ -------------------------------------------------------------- Owner By -------------- /.0 --�----0 ----------------------------------- title /�--� - ------------------------ ------------ (If other n owner) I FOR—,DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -----rrL, 4� - --- -- - ------------------- -- -------. DATE — - -` BUILDING PERMIT ISSUED ---DAT . ---------- ------------------ - ------ ADDITIONAL COM-IM- -E--NTS } ---------V ---- ----- ..� - - ---- - k ------------- --- ------- -- -- ------------- r Final Inspection by: --------- 3- --- --------------------------- Date SAN J AQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M