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APPLICATION FOR SANITATION PERMIT _..._............. `� � (Complete in Triplicate) Permit No. .7 .:---`3 Date Issued ----- ___ .-___----- --- ---- ------ This Permit Expires 1 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 is made in compliance with County Ordinance No. 5549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ----�2 !Z V'l- J� ---------- _CENSUS TRACT .............. ........... Owner's Name �� - ( arz�� . _---.-__-__Phone Address 7.,..F. �: DCr ----------------- --•----•--. City - --------------------- --- --Contractor's Name . . - License #Z' 'Z Phone --•.-.-•-.-.•Installation will serve: Reside ct ' tment House❑ Commercial ❑Trailer Court ;❑ Motel�q Other -- --- ------------------------ / k Number of living units:. [ .... Numb of, elproms 3.......Garbage Grinder ._...... Lot Size ._0. -__-_.-__------------------------ 1 Water Supply: Public System and na tt .........................................Private Character of soil to a depth of 3 feSand Silt F] Clay ❑ Peat E] Sandy Loam C] Clay Loam VHa ❑ pan Adobe ❑ Fill Material ... ... If yes, type .-__......._-_....._._._. (Plot plan, showing size of lot, loc of syst in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSI7�CL7Cflt5 o sep c tank r seepa it permitted if public sewer is available within 200 feet,) ` f PACKAGE TREATMENT [ ] SE TIC TAN .� Size-_.._-___--_-____-..__.__......... .... .... Liquid Depth _..-._.-.-_...._..__..._-- N Capaci ../ZC9U. ._.. Type Material_ No. Compartments 1L................. a, tance to neares ell ........ _....-___.__._..__Foundation .. V......_.._.__ Prop. Line ---41( LEACHI G LIN gr,of Lines _�-;�__ _-...- Le gtr�4 of a ch�plin�e.._�6. �..._. __... Total Length .._.__� Q -__.____.. !istance Box _. TypeVter Mat ialj� Depth Filter Mate�tial m i o nearest: Wol 4►(�..... ......... Fou _��------__---�jpro erty line,(..._.._..._..___.SEEPAG PIT Depth[ P j '�. _ -- -- Dia lir �.. 1�__ Nu ber _--------------- Filled Yes �No Q Water Table Depth __. iiize ----- -------------------- �` jDistance to nearest: Well ____ _ ___________ _ .............Foundation ��-_.......-_ Prop. Line ..._.__....____...___. REPAIR/ADDITION(Prev. Sanitation Permit# ........ ..... ._--.._..-.- _-- -------- Date ....................... Septic Tank (Specify Requirements) .. - -- - --------------- -------------- ----------- .. ..... .. -- --..............._. Disposal Field (Specify Requirements) ---• -----------•--•---•---•-•----- --------------- ...... ---------- --------•---- -------•--------------------------- --- _.-.....---------------------- ------------------ ------------- ---------- -- --- ------ . -- ----------. -------- ---- -- ------- ------------ ----------- ---------- ----------- (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 become SUMP u le to W�X1 or n's Compen tiRn laws of California." Signed --- - - ... .:-.--:-:----c-�:.:4-,-.r4wr�er--._..._... - ------- -------- (If other than owner) O D PARTMENT USE ONLY APPLICATION ACCEPTED BY _.._......_jk _ .. ----- DATE (.�'.20-7---------- -- ----------------------------- BUILDING PERMIT ISSUED ....................................................... -----•------------- ---•- DAT . .....-------------------------- ADDITIONAL ...... ... .......... ADDITIONALCOMMENTS ------- ----- ..---•-------------------------------------------------- --- - -- ------------------------------------------ --- ----- -------------- -- --- -------------- - -- --- --------------------------------------------------------•-•-•---------•-••---- ----------------------------------------------- _.. ..-.... - ---------- -- -- ----------- ----------------------- ----------•----••---•-•---------------•-------------- --•-------------------------•-... . ------. ---- --- -.... ..... - � ---Final Inspection by: _�................ Date SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M