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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 7 Permit No. --7----------------- ---- ----------------------------------------------- (Complete - -- -- (Complete in Triplicate) -------------- Date Issued __/�2 -3`7y 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. 549 and existing Rules and Regulations. r / Ae Arm.-----CENSUS TRACT -------------- ------ JOB ADDRESS/LOCATI N _.l�r-7--- ---:- �P--- --- ----a4.�P_!- ---- _-�----- ^-• ----- Cit Owner's Name _ __ _._.__ cP - ----------------------- ---------- Owner's 'Z" t-l_-- -------- Y ------------ Address - -- -- ----------------------------------License # ------------------------ Phone ------------------Name --------- ---------------------------------- � ❑ ❑ Installation will serve: Residence A artment House Commercial : Trailer Court Motel ❑Other -------------------------------------------- �. Number of living units:- _'----- Number of bedrooms �-----Garbage Grinder ------------ Lot Size ---------_'Q_'---.-------------------•----- _ - _ Private ..••=-w -- - Water Su.pp.Ly:.Public.System .and name ---------------------------------------------------------------- --------------- ---------------••-----__------------------=- Peat Sand Loam Clay Loam Character of soil to a depth'.of 3 feet: Sand'❑ Silt[] Clay ❑ ❑ Y ❑ f Y : Hardpan❑.V\Adobe [] Fill Material -------- -- if yes.type ------------------------ t- buildings, etc.,rf sQ be placed on reverse side.] (Plot",plan, showing size'-of in wells, NE N: {No septic tank or seepage pit permitted -+f public sewer, `.av'ailable within 200 feet,) PACKAGE TREATMENT [ I SEPTIC TANK'{ I Size---------------------------------- Liquid Depth ------------------------ Capacity - -------- ---- Type -------------------- Material-------- ------------- No. Compartments ----------------- Distance -- ------------Distance to nearest: Well ------------------------------------Foundation ______--------------- Prop. Line ____.____-_----..----- Length of each line----- ----------- Total Length ------..---••---\.-....-- LEACHING LINE [ ] No. of Lines - 9 -----�- - - ---- --- -- ---Depth Filter Material ---------------------- --------------------- 'D' Box ------------ Type Filter Material _________________ Distance to nearest: Well _______________ Foundation _--'_'"" ----- Property Line --•-----------•--------- Depth --- Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No C1 ; SEEPAGE PIT [ J p ---- --- ----�- - ' Water Table Depth -- -- -------- Rock Size - I Distance to nearest: Well --------------------------•-- Foundation ... ---•---- Prop. Line ----•---------... C REPAIR/ADDITION(Prev. Sanitation Permit# ------------ ------------------------------- Date ---------------------------------- ----------- Septic _______------------------ -----Septic Tank (Specify Requirements) ______________ Disposal Field (5pgcify Requirements A)e-------�--- -� Q - '"" - ---------------- ----------------------- ---- — ------------ -- _ -- ----------------------------------------------------------------------------- - (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 k 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 beco a subject�orkmar o ensati.on laws of California." Signedi----- L �`1 --------------------------- Owner fTitle ------------------- --------------------------------------------------- lBY --- -------------------------------------------- (if other than owner) FOR DEPARTMENT USE ONLY t ! 7-------------- APPLICATION ACCEPTED BY ----- - ----- -- - -------------------------- - DATE - ---`-- -� BUILDING PERMIT ISSUED -------------------------- - ---------------------------- ---- --------------DATE - -----------•----------------------- ----• ADDITIONAL COMMENTS ---------------------- i ------------------- -------------------------------------------- ------------------------------------------- 1 --- -- Final Inspection b ------------------- ------------------------ .Date lJ"- - ----- ----------- ------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT y E. H. 9 1-'68 Rev. 5M