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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ---------------------- --- (Complete in Triplicate) Permit No. 7. --------I-- ---- ------------------------------------- - ,A --- - - ----------_-----_--------- -------------------------_- This Permit Expires 1 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 compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATIO C1 _ � - - . _--- -------- ---------------CENSUS TRACT RACT -------------- ----------- -- l � t _ Phoneqr!_7p. ..Owner's Name --------- Address - ------------------------ city Contractor's Name � - - 58 � License # 5-� Phone . Installation will serve-, Residence %Apartment House,❑ Commercial ❑Trailer Court a � r Motel.[D,Other ---------- ` = v.. ; ---- ----` ! Number of living ugits:A____ ____ Number of bedrooms _-- - 'Garbage Grinder ------------ Lot Size -"'___f �%--`'"�"` ------ Water Suppl.y.:QPublic System and name -------------.------------------------------------.--------------------------------------- - .-----------------Private Character of soil to a depth of 3 feet: Sand❑ Silt I-] Clay L.❑. Peat❑ Sandy Loam -❑ 4 Clay Loam ❑ Hardpan ❑ Adobe he Fill Material ------------ If yes, type ___________________________ i -O {Plot plan, showing size of lot, location of system in relation�to`we11s, 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,) 4 -"o . J PACKAGE TREATMENT [ SEPTIC TANK ] " ` Size__`=:---------'�-=---_'---------------------- Liquid Depth -------------------------- (� Capacity ------ ----`-------- Type -------------------- Material---------------------- No. Compartments ---------•------------ N, Distance to nearest: Well ------------------------------------Foundation-_-------------------- Prop. Line ----.----------------- LEACHING LINE [ ] No, of Lines ________________________ Length of each line--------------------+------- Total Length ----------- ---------------- 'D' Box ------------ Type Filter Material ____________________Depth Filter Material ________-____________________---_____-____-_ Distance to nearest: Well _________________ Foundation ------------------------ Property Line ...._________-___i e ._____ SEEPAGE PIT [ ] Depth ------ ---- Diameter __!______________ Number ------- -___ Rock Filled Yes `Q No C] w Water Table Depth ----------------------------------- --------Rock Size------------------------------- , Distance to nearest: Well -----------------------------------`--.Foundation ------------_...... Prop. Line ' REPAIR/ADDITION(Prev, Sanitation Permit# _________________ -- f Date -------------- -------------------------------- t 4 1 Septic Tank (Specify{Requirements) --------------------------- -------- J---- � -- _ Disposal Field {Specify Requirements) ��` r~ !tel--- ------ � --------------- Specify T� �I o 'r r�g 3j? ______________________________________________ -________-__ 1�1 J_--____ _____ -____._______________________ (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 "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." Signed ---- ------------ ------ ---= --- --- ---------------------- Owner t BYTitle'-`------- = -------------------------------- f o er th wned FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -------------------- -------------------------- DATE Z'- Z- BUILDING PERMIT ISSUED DATE � '�ADDITIONAL COMMENTS ---c,,2 -------- 1� ----------------------------------- ----------------------------------------------------------------------------------------------- --------------------------------------------------------------------- ----------------------------- -----------------------------------------------------------------------------------------------------------------------------------------------•---- ---------------------- Final Inspection by: ---Date _jl-:-...- ------------------------ SAN JOAQU.IN LOCAL. HEALTH DISTRICT E. H. 9 1-'b8 Rev. 5M ---'-