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FOR OFFICE USE: F APPLICATION FOR SANITATION PERMIT ------- ---- --- ----- ----- - Permit No. __ 3 (Complete it Triplicate) �� ______________ --------------- This Permit Expires 1 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 a d existing Rules and Regulations: �+ b , JOB ADDRESS/LO�ATION ___ __ _____ �.4'��--___lcvll -___CENSUS TRACT ____._Owner's Name - ----------- ----------- r _ ---------Phone _ _ ------ l---- -- ------- - --dam Address ------------1,1- 4----- - _ P__. City - -- - - ----- - ------------------------------------- Contractor's Name -----------------.License #4!7e_ZV Phone _1/`3�__-4_ _ Installation will serve: Residence Xr Apartment House❑ Commercial ❑Trailer Court I❑ Motel ❑Other ------------------------------------------- Number of living units:----/------ Number of bedrooms --3------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 av '(pble within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK{ ] Size--- - Liquid Depth -__ ______-. Capacity,&QQ____.__ TypZ-)0_<L_4_A&_4_ Material_, , No. Compartments 6 Distance to nearest: Well ____ _ r -------------------- Foundation --< - Prop. Line ' - ------ O LEACHING LINE No. of Lines ____ Len f [ l - ---------- Length of each line_ ___7,r______.____ Total Length ____ __ �_____________ D' Box ___L____ Type Filter Material epth Filter Material ! ------------------------------------- Distance to nearest: Well _t_QV-------------- Foundation _ �___________ Property Line __ylQ7�_`.......... it SEEPAGE PIT [ j Depth ---ot_✓____-__ Diameter 3�_--13Number __ _�_ _ Rock Fillyd, Y [� No C] i 1 1 Water Table Depth ------ 0- ----i---------------------Rock Size _d �'(?d �exr .17 Distance to nearest: Wel! __�Sd___________________,_ - r Foundation `764-_________ Prop. Line __4!_____________ REPAIR/ADDITION(Prev. Sanitation Permit# -------__----------------------------------- Date _________-_-____________________) O Septic Tank (Specify Requirements) -------------------- ---------------- •----------------------------- Disposal Field (Specify Requirements) ------------------------------------- -------------------------------------------- -------------------------------------------------- --------------------------------------------- - ----------------------------------------------------------------------------------------------------------------- - (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- 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 become subject to Workman's Compensation laws of California." Signed - --------- - ---- -- ---------- -- - - Owner -- ---- ---------------- -- ------- BY -L��'-- - -- - -�- - - �- ,.�+Gt- ----------- Title ��. (If other than ow 49 F ARTMENT SE ONLY APPLICATION ACCEPTED BY ------- - ___-- -- �-- - 9� -------------------- DATE -- ._---------- BUILDING PERMIT ISSUED ______ ___ _ /j DATE _ ___-___. ____!________.___.______ ---- - - --- - -------- ---- ------ ------------------------------------------- ADDITIONAL COMMENTS ------- --- _ _ ------------------------------------ - - - - - -- - - Final Inspection by: ------ -- - --------------Date SAN JOAQUIN LOCAL HEALTH DISTRICT P k.._. E. H. 9 1-'68 Rev. 5M