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G FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT z �3 �. -----------r{ --- ----;f---------------- - Permit No. 7 r - (Complete in Triplicate) ` Date Issued __ -a__9_-- This Pe�rriif Expires.TYe6r Frorh-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/LOCATION ------ TRACT ------ --- --------- Owner's Name ---vl_eg/6--------/_11_/? h-J7--------------- -------------------- =y - �� - - - ------------------------- Cit �,�`-t -------------Phone--------- �-/----- - Address 2' 2- lt' QPa � � Y-- .'-- ' Contractor's Name -------- 'el - ---------------------- ---------------- `License # --------- `------------ Phone ------------------------------ Installation ------------------Installation will serve: Residence�Apartment'House,❑ Commercial :❑Trailer Court ',❑ —7/J'3 Motel [:]Other ---/ t_``0.6 j, o--- fl GC-� , 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 ❑ Peat❑ Sandy Loam M 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 TANKP( Size------------------=---=---------•------------- ----- Liquid Depth ----------------------- - Capacity 1�_ 0_______ Type J"!/� - Material�1a^�-d_ yr (No. Compartments __-�.------------ `tit _______-- - Distance to nearest: Well -----y5�------------------- _`•_Foundation %-'S----------------- Prop. Line ___ _______ _ tV .LEACHING LINE [L]�No. of Lines ------------------------ Length•of each line—------ ...---'- Total Length -----1�z'srZ_______ _._ D' Box 5pxc______ Type Filter Material-SP -Depth Filter Material °'_:____/ ----------------------- Distance to nearest: Well ---<-TV___,__ ______ Foundation ____ ___ ___________ Property Line ------------------- ---- SEEPAGE PIT [ ] Depth ____________________ Diameter ________ ------- Number-,:-_ ------I----- ------f---_ Rock'Filled Yes ❑ N 0 Water Table Depth ----------------- ------ __ Rock Size :-------------- ---- Distance to nearest. Well ------------------- ------Foundation -------i------------- Prop. Line ---------------------- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------- --------- Date --------------------________.-_--) t SepticTank (Specify Requirements) ------ =--------------------------=------ -----------------------------------------------------------------------..--------------------------- Disposal ------------------- -•---Disposal Field (Specify Requirements) ------------------------------- s --- --------------------------- ------------=------------------------�. -------=---------------------- ---------- - t p p (Draw existing and required -- on -reverse side) q I herebycertifythat I have prepared this application and ithat'the wo k will be sdone in accordance with San Joaquin � County Ordinances, State Laws, and Rules and Regular ions of the San:Joaquin Local Heallth District.-Home owner or Licen- sed agents signature certifies the following: . r a �' "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 beco a sub' ct to Work a 's Compensation laws of California." .p g -------- Owner Signed = r EBy ----- --------- :-- -------------------`------------------------- Title -------------------------------- --------------- ------ (If other than owner) .� F lt-D`EPA1t ENT USE ONLY APPLICATION ACCEPTED BY -- ------ DATE -----/C'--r--3- BUILDING PERMIT ISSUED ------------------ ----- -- -------DATE ------------------------------------------- ADDITIONAL COMMENTS --------------------------------------------------------------------------------- ----------------=----------------------------- ------------------------- ------------------------------------------------- ------------------------- ----- ----------------------------------------------------------------------------------- � ------ -_� ----------------- - }` Final Inspection by: --------------- -------------------------------------- ------------------- -- - ------Date --------------------- - -------- SAN -----SAN JOAQUIN LOCAL HEALTH DISTRICT G� E. H. 9 1-'68 Rev. 5M