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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT - ---------------- Permit No: -7U — (p-- (Complete in Triplicate) --- -------- --------- ---------- - -- - This Permit Expires I 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: f� - CENSUS TRACT �"�- --------- I JOB ADDRESS/LOCATION .-��-�/-�---- =---- -- -�--- -`- - Owner's Name ------- ------------ ---•- - ----------•--------------------------------------------- --- ------------- - Phone •----------------- Ci#Y G1'".> - --------------------------------------------- Address ---------------------------------- ---------- I Address --------------------=- ------ - �' `- - �'°� ------License # /I_�-?�__o--- Phone 77_V! Contractor's Name ------- -f-.r''- -- ----- ------ -- -------------------- ---•--- Installation will serve: Residence)<Apartment House❑ Commercial ❑Trailer Court Motel ❑Other ---------------------------------------- Number of living units:--------- Number of bedrooms _,3_----Garbage Grinder ------------ Lot Size ------------------ --- Water Supply: Public System and name -------------------------------------------------------------- ------------------------------------------ Private4j Character of soil to a depth of 3 feet: Sand'❑ Silt fl Clay ❑ Peat❑ Sandy Loam Clay Loam,0 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,] X-1�------------------- Liquid Depth _:4/- -•---.----- Size----- --- --------- - q p V1 PACKAGE TREATMENT { ] SEPTIC TANK qq 1 Capacity _ ------- Type __1__u,(rW 4_, Material_ - ------ No. Compartments _-_ems,-- ---.---- -_Foundation __--. 1-1 Prop. Line _-_ Distance to nearest. Well --_--- —---- - --- " - Length of each line---------- - ---------- Total Length !-_. - ------- LEACHING LINE [ ] No. of Lines --_ -- - 9 Depth Filter Material ____�_ ----------•----------. ; D' Box --_ - Type Filter Materia_ P -- l� --_------ Foundation --_ r -------------- Property- Line -- ------• � Distance to nearest: Well .......5-V PIT [ Depth --------------------- Rock Filled Yes No ] ------------------ Diameter. Number _ . , r Water Table Depth ------------------------------------------------Rock Size Distance to nearest: Well ------------------- - -----Foundation -------------------- Prop. Line ---------------- REPAIRfADQITION(Prev. Sanitation Permit --------------------------------------------------------- Date ----------------------------------) I Septic Tank (Specify Requirements) -------------- -----I-_ ----------------------------------------- " ------ ------------ ---------------------- Disposal Field (Specify Requirements) ------ ----- ----------------------------------------------------------- -------------- ------ ----------- -------------- ----- ---- i - - - t -------------------------------- ------------------------- ------------ - - --- ------- - ----------------- i (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- r sed agents signature certifies the following: "I certify that in the performance of the work for ich this permit is issued, I shall not employ any person. in such manner as to beco a sub* ct t,v rkman's Compe�atio'laws of California." �� Owner Signed ----!N--�'---------------------- -------------------------------- Jitle - -------------------------- By (If other than owner) F R .DEPARTMENT USE ONLY .. � APPLICATION ACCEPTED BY -- _ :- ----------------------- RATE -__ -------- BUILDING PERMIT ISSUED ------------------ ------------------ -- -------- --DAT£ ------ -----•----------------------------- ADDITIONAL COMMENTS ----- -- ------------------ -------------------------•------------------------- --------- ------- - ---------------- ----------- --- ------------------------------- --------------------------- - -------- --- ---- --- - -------------------------------------------- -------------------- _Date ----�--J--f---�------- --------------- --Final Inspection 7 ------ --- - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M