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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. 7...__.___._-_____ -- ----- ------------------------------I---------- i --____-------- 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: JOB ADDRESS/LOCAT _11-551 - - - -- --- --------..CENSUS TRACT ------------------------- Owner's Name ' - - Phone Address 's -- -GG - - ------- - ------ -------- --. City ,^ - - \l f Contractor's Name -.. _...-V+ -------i-----.License # / - `_ Phone 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'❑ Silt❑ Clay EJPeat❑ Sandy Loam ❑ Clay Loam [IHardpan Adobe [-1FillMaterial _.._ ------ 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 see pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK'[ R Size_ _ __. __ Liquid Depth V---71- (� r Capacity _/_6©O-------- Type ____--__ -/-_ -_/�___. Materia No. Compartments ___________ V Distance to nearest: Well _-_-_-J---- f..-___-______.__Foundation _-_-_f-b_I--------- Prop. Line 5_______________ LEACHING LINE [t No. of Lines ------- ?-------- -- Length of each line... ...J. _p__j-__-_ Total Length -__ 4 � /_______ 'D' Box .___ ____-_ Type Filter Material .-_ts,_ -_-_Depth Filter Material _.__L�- ___.__._ � . Distance t nearest: Well . --So Foundation ___/_Q__-`___.____- Property Line ________________--_-___ SEEPAGE PIT [ Depth -_- S-f._-_ Diameter __ _`'� Number --__- ----_- --_---- Rock Filled Yes [� No i❑ Water Table Depth ------------ � Rock Size ._��Y 3 to nearest: Well ---______It&---_______-________Foundation -----L f7_-1------ Prop. Line --,V_______________ REPAIR/ADDITION(Prev. Sanitation Permit# --------------------------------- --------- Date ----------------------------------) SepticTank (Specify Requirements) ------ - -------------- - ---------------------------------- -------------------------------------------- --------------------------- Disposal Field (Specify Requirements) ____-______________-___.____ _____-______ ------ - ------------- -- ---- --- (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 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 Com ensatiAn laws of California." Signed ---- - --- ------ -- - ------- ----- ------- Owner By ---------- ------------------------- ------- Title (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .. --- ----------- BUILDINGPERMIT ISSUED ------------------------ - ----------------------------- -- ------------------------DATE -------------------------------------- ADDITIONAL COMMENTS -- -------- --- -- --------------------- -- ---------------------- ---------------- --- ------------------------------------ --------------------------- ------------------ ---------------------------- ------------------------------------------------- ------------ ------------ ---------- -- - - Final Inspection by: _- --------Date ..-._=/ZIrr71._. SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M