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FOR QFFICE USE: APPLICATION FOR -SANITATION PERMIT ' - Permit Na. ._ .. •-. ._.;.-:.................................... (Complete in Triplicate) ... ................................... Date Issued ..........._. ................. Application 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: JOB ADDRESSAOCATION '.�. .. ..... CENSUS TRACT ,�1 i,� _ ._-Phone Owner's Nome .---- .... City Address - --r ��. _ .. �✓-.� License # `c].__�f,a2. Phone�. . Contractor's Name .:.... } Installation will serve: _. .��.ResidencedApartment House Commercial ❑Traller Court .0 � Motel ❑Other _-----•-•--------_----------•---------- ...- ..... .......................: Number of living units:-__�__.,._ Number of bedrooms ...... ...Garbage Grind lot Size r Pr t W --------------------------------- .- iva ater Vupply: Public System and name .._...__•...•••- . . -- ++ Character of soil to a depth of 3 feet: Sand❑ .Silt❑ ClayX ' Peat❑ Sandy Loam .0 Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material ............ If yes,type ---- .......... we (Plot plan, showing size of lot, location of system i relation to wells, buildings, etcmust be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public!ewer mailable within 204 feet,) r� PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] Size- .............. Liquid Depth Capacity .... TY rpe ' �'�� Material---------------------, No. Compartments ..�........•..•. I .... Pr t •-•-•----.. ... Foundation .�.�---._.... op. Line ` Distance to nearest: Well ...... ��•--••=-_--------•••= - Total Lengths -••,-•••--•• LEACHING LINE [ ) No. of Lines -•-��`- ---------------- gialh.:�j�_.Depth Filter Material ... .................. . Length of each line....... �1....:......... F 'D' Box -.1.___._-- Type Filter Mater Distance to nearest- a rest: Well ._....:-----••--.- -.,.. Foundation ........................ Property Line -•-• ....... �.- ...tea .. ., - Rock Size ................................ Water Table Depth ....................v...---•------ ... [ ... Pro Line _--•---------- -•----•----...Foundation ............. ------ -�" ( Distance to nearest: Well •"' . ,� REPAIR/ADDITION Prev. Sanitation P�rmit�# A Date ..........::....••••--•-----•-•---� -•-••-f•--�� -- Septic Tank (Specify Requiremen ) ..._....__. - - r - �--------•------------------- Disposal Field (specify Regvirements)i ...._--•- �. •-•--•-------� -�,..�• �.- M i ........................ 3 i � • _________________________________________ ~_�_^_..__._....____--._____---.-_..___..__...__._.........__........_.___.........__....___.._. y-- .. {Draw existing-and-required addition on reverse side) lication and that the work will be done in accordance with San Joaquin 1 hereby certify that I have prepared this app County Ordinances, State Laws,,and Itules and'Reguldtiio-%-of-the San 9oaquin Local Health District. Home owner or liven- } sed agents signature certifies the fallowing: t "1 certify that in the performance of the work for which this permit is issued, I shall not employ any person In such manner k as to become subie to Workman's Compeniation;laws o#California." t� rt_� - - Owne t .- ...---••---•-•---•_... Signed .-.C�.: r-----f-..--- ........ ....................... •. -' t .......... . ;title _.-A------:............... By •--• ..... ....................."-------- ----- (if other than owner) FOR DEPARTMENT USE ONLY 4DATE APPLICATION ACCEPTED 8Yf. -------------- .YL --,BUILDING PERMIT ISSUED ATE .............. i r ------------------- ADDIT--TONAL COMMENTS ! .... --•... ............................. ---• ....-----•. .....Date ... .. Final Inspection by. SAN JOAQUIN LOCAL HEALTH DISTRICT ' F 7/72 3 M i 7� ell