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FOR OFFICE USE: —APPLICATION FOR SANITATION PERT r/ 1 = i ) Permit No, . / (Complete in Triplicate) �- ________ _________ _-________.___________ Date Issued _----------------- This Permit Expires l 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 iwa�e in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION _ ---'-WK--- 7 ---- - --------•- -------------CENSUS TRACT --_-----------•-----:----- Owner's Name = Phone -- ------- ------ City g �r - _-_ -� fAddress � 1 --- Contractor's Name ' _ _-_ -" .._ _Ecr __ -� �#%_,License # _2-e- ----<S- -/Phone _.6- jInstallation will serve: Residence (Apartment House-j] Commercial ;❑Trailer Court ;❑ a 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'[ Sift❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material ------------ If yes, type ____________________________ IPlot 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,) - V PACKAGE TREATMENT [ ] SEPTIC TANKI r' Size----/- - -a___.- --------.- Liquid Depth -------------------------- S Capacity /„24_0 Typeek Material- No. Compartments ------a---------- C ` 3 I Distance to nearest: Well ----46AY--------- -------Foundation __1 `'_ Prop. Line LEACHING LINE [ ] No. of:tines ------�------------ Length of each line-----7(�-------- ------ Total Length _______________ 'D' Box __-_-_-_ Type Filter Material &a�Ue th Filter Material Distanee'.,to nearest: Well ------ :- Foundation --------IQ------------- Property, Line. ---- ---------------- SEEPAGE PIT [ ] Depth Diameter --- Number _________________________ __ Rock Filled Yes to No Jo Water-Table Depth -------------------------- --------------Rock Size -----i ----------------- Distance to nearest: Well ------------------ _------Foundation ----------------_--Prop. Line -------------:_------- REPAIR/ADDITION IPrev. Sanitation Permit# ------------------------=------------------- Date ----------- - ------------------ Septic -----------------Se tic Tan (Specify Requirements) ------------------------------------= Dis osal Field (Sifecify Requirements) -------------------- - ---------------------------)------------------------------- - -1 --------------------------------- ------ , , r --------------------------------- ------ ------------------------- --------------------------------- --------- ----------------------------------------- ' ]Draw existing and required addition on reverse side) I -hereby certifythat I have prepared this application and that the work will be done in accordance with San Joaquin i 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." ISigned ------------------- ------==---------------- ---------------------------------------------------- Owner a ;By s � title __... --------------------------------- -------- j {If other tha ow FOR DEPARTMENT USE ONLY l ---------------- - Ir --- - -' � APPLICAT[ON ..ACCEPTED BY - --- --- - ----- --- - --- -------- -------- ------ DAT , UILDING PERMIT ISSUED ---------------------- _DATE --------- ------------------------------ - -------------------------------------------------------------------------------- ADDITIONAL COMMENTS --------------------------- -------- '�N -------dl----- -'F -�t___ '-------------------------'-_-- -- ----------------------- --- ----------------- -------------------------- -------------------W----W---W----- -- --------------------------------------------- -G ----------------------------- ------------------------------------------------------------- ---------------------- --- nq�,, .- ------ -- ------ ------- Final Inspection by Y-w" `7-- = ----------Date -�_' --��------------------ t' SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M �'.