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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ----- ---- -- -- -_- (Complete in Triplicate) Permit No. D - ------------ ____ ___ ------ --- This Permit Expires 1 Year From Date Issued . - - Date Issued __S__�_-_711 • Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein -4 described. This application is made in compliance with County Ordinance No. 549 and existin Rule JOB ADDRESS/LOCATION - - g sand Regulations: _ _ -------- Cvof�f'� _�l� s � _ .� Owner's Name `� --------- ----�-�1 CENSUS TRACT ---•------- Address �7 x ?-Y .- ego_I/ '. cit yp Contractor's Name Y �� Installation will serve: T -----------License # _�� // Phone f ~ Residence N Apartment House 90 Commercial [Trailer Court ;❑ Motel F1Other Number of living units: : _,„Number of bedrooms ---Z---- Garbage Grinder ----- ------ Lot Siiei _ , Water 5uppiyk Public System and name ------------------ xs Chd`racter of soi! to a depth of 3 feet: Sand' ------------------------------------- -----------------Private , �--�-- --- --.- ❑ Silt❑ Cloy ❑ Peat � ❑ Sandy Loam .❑ Clay Loam 0 Hardpan ❑ AdobeFill Material ------------ If Yes, type ------------------- (Plot,J,plan, showing size of lot, location of system in relation to wells, bldings, etc. must be laced o NEW INSTALLATION: (No septic tank or seepage t permitted if public se er is available p n reverse side.) PACKAGE TREATMENT P� p e within 200 feet ,. a-paw TANK l • •Size'' ------------------ PAC ---------- --- Liquid Depth ,� -- Type -------------------- Materia)--- ----- - V Distance to nearest: Well ----------- No. Compartments ______________________ 1 LEACHING LINE ............................... ------ --------- ---------• Foundation ---------- --_-- No. of Lines --- Prop. Line . --------------- 'D' ---- ------ \ t ---------- Length of each line---------------------.------ Total Length -----------_-----_-------- Type 'D' Box -____.__ _-- Filter Material ---^_-------------Depth Filter Material ---_ ---- \ Distance to nearest: Well -------------- - ---------•-------•------- --•--•- : SEEPAGE PIT = Foundation _ Property Line --------------------- - Diameter -------•---••---------- t 1 Depth ----- ----1--------- --- -- Number ----- -- I Rock Filled Yes .❑ No Water Table Depth �- ------- ----.Rock Size Distance to nearest: WellP11 ------------------------------------------------------------------------Foundation REPAIR/ADDITION(Prev. Sanitation PJm!t#� ------•.--- _--- Prop Line ------------- 1 ---------------------- Date ---------------------------I Septic Tank{Specify Requirements f_/pr' Disposal Fibld (Specify Re u,rements - ----------- ----'-� I- ------------ � .. .: --- ------ ----- -------------------------------- '---- I -%- . ', ------------------------------------------------ -- '------ i �` (Drawexisting and required addition on.reverse side) hereby certify that I have prepared this application and that the work will be done in accordance County Ordinances, State Laws,�and Rgles and Regulations of the San Joaquin Local Health District. Home # rdance with San Joaquin sed agents signature certifies the-,following: a owner or licen- "I certify that in the performance to of the work for which this permit is issued I shalt not em as to become subject to Workman's Compensation laws of California." employ any person in such manner t t � r :yA ---- ----- --------------- ------- ------- r Owner ---------------- ----------- Ifti= = ---------------- --------------------------------------- other than owner) Title _- .-- �.-------- if FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED By BUILDING BUILDING PERMIT ISSUED .- ADDITIONAL COMMENTSDATE _ --- DATE ---------- - ------- ,'�._ - --------------------------------------------------------------- ------ ----- - -•-r--------- ¢ _�E __-� ------------- ------------------------------------- ---------- - --- -- - Final Inspection b o ------------------ -------------------------------------------------------------------------------------- ----------- ---•---.Date ---�'"__ '7 -- ----� SAN JOAQUIN LOCAL HEALTH DISTRICT E. H, 9 1-'68 Rev. 5M