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FOR OFFICE USE:. APPLICATION FOR SANITATION PERMIT , Permit No/7 lComplete in Triplicate) This permit Expires 1 Year From Date Issued Date Issued . ..l.J 7 ...................................................... _ I 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 ADDRf55/LOCA7 ---��.1--�. .....��.....-l--iC-l� ... ..................................CENSUS TRACT .......................... Owner's Name ,�-_... ----- _._..._.. ...............................;............. Phone .........., _....... Address ... .�f0 ......City i Contractor's Name ��• License # ��J�d? ^.. Phone ...................... Installation will serve: Residence. Apartment House Commercial pTrailer Court 0 Motel Q Other ..... i 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 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 .[ I SEPTIC TANK l ] Size...------------................................. Liquid Depth .........................� � F6 CapacityType .............Material..................... No. Compartments .....................;r I Distanceto nearest: Well a _................ Prop. Line - ..... No. of Lies -------••------ -Length of eachIinBLEACHING LINE .S Total Length .__.........................Z D' BoxTyp e Filter Material s .........Depth .Filter Material ............................................ Distance to nearest: Well ............... Foundation ---------------------•..; Property Line .............---........ Rock Filled Yes No SEEPAGE PIT [ ] Depth -------------------- Diameter .---.•••.--.---. Number __..--------....----...._ ❑ i❑ Water Table Depth -------------------------- -------------•- Rock Size O Distance to nearest` Well .�......--•--•---•--•=-•••---•-..........Foundation ..... ............ Prop. Line ........................ i � REPAIR/ADDITION(Prev. Sanitation Permit ------------ ....................... Date ...--._.........------------- ......} i Septic Tank (Specify Requirements) -••- --•-- = = = --'.......................•----........... .......................................................... Disposal Field (Specify Requirementsl ... ................. 'g'"'Ile' --------------- ----------- ` --............ _ . -� (Draw existing and required addition on reverse side) I I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State Lays, and Rules and Regulations of the San Joaquin Local Heaith,Distriet. 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, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ------- --- ------------ Owner --- Title --- �.... (If other than owner) i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _.. - -------------------- ©ATE BUILDING PERMIT ISSUED --- ----------------- - --- .....DATE -------------------- .................... ADDITIONALCOMMENTS ---------•-----------------------------------------------....-------------- - • - --------. - •------------ ------------------.----------I•------------ - -•------------- -------- ------- _.----------._.._--•--- -----..----------•--• -- • .......-...------- ---------. ---------- .. - __ '. - w � ...... ................_.__._... Date _ Final Inspection by: - . r , EH 13 2b 1-68 f ev. 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 874 3M ce)I