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�.� FOR OFFICE USE: APPLICATIONi FOR SANITATION PERMIT S"7/ Permit N?.............. IC. ..1`" omplete in Triplicate) ,... _ . } Date Issued,;�:_..S.�_? . ...................................................... This Permit lXp ires 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 vrith County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .: .CENSUS TRACT Owner's Name ............... 'fir----------------.._.-•-•---• -.. _ Phone.. .7:. ...... �. .. Address/ .( 4.......- ----•-_.... City . • - •• . .......... ................. .................... Contractor's Name .. _ _. ' _ ':��'.`. _��,,�' . ....�':__.�""-_License #�5�=:-.?.-_�J?_.�-:-Phbne•-:��_.:�`•_�Q,7 Installation will serve . `Resitlence Apartment House 0 Commercial ❑Trailer Court Q ` �4 Motel CI-Other ............................................ * --- 1 Number of living units:.... _.._.._ Number of bedrooms _,.,J Garbage Grinder __.. Lot Size ....�6.... 1 . i Water Supply: PublicSystem and Hartle ...............- _Private ❑ �.._ Character of soil to a depth of 3 feet:I Sand❑ .Silt 0_ oy Sandy Loam ❑ .-CloyLoam, Peat❑ , ❑ � Hardpan ❑ Aclobe/�( FillMaterial .......3`_''_~If•yes,type�._____ - �-�___ �_ f (Plot plan, showing size of lot, location ofsystem in relation to wells,.buildings,-etc.-mustibewplaced_on reverse side.) NEW INSTALLATION: 1 i iNo septic.ta'k or seepage pit permitted if public sewer is available within 200feet) PACKAGE TREATMENT [ I SEPTIGTANK I ] Size...... ..... _•............................... Liquid Depth _...__.._. .......... i Capacity -----• ............ Type ..--•............... Material-------------._ No. Compartments gg ... ....:... Distance to nearest: Well .................._...... _______.__Foundation ...................... Prop. Line ._ ..........._00 3 LEACHING LINE [ ] No. of Lines _____________________ Length of eoEh line............................ Total Length ........................... -• 'D' Box _._._.. ---- Type Filter Material ............. ..... Depth Filter Material -------. _---____... -r' . O Distance to neatest: Well ........................ Found tion Property-Line 1 �t SEEPAGE PIT [ } Depth _...__,..t_._..`:._ Diameter ________________ Number ............................iRock Filled Yes ❑ No t., ! ii Water Table�Depth ._ ............................. ....Rock Size ___............-:_......... .. �� i i 'a � Distance foxnearest: Well........................................Foundation ............ ..---.. Prop. Line ........._..-----___.y i REPAIR/ADDITION(Prev. Sanitation'Per reit# ...................................� Date __•_--_-•-__--__--..._ ........ � y Septic Tank {Specify Requirements} ................ ... .. :..... .. 6 _..............._., -••-----•-- � a Disposal Field {Specify Requirementsl ...�- - ----•-•---- -• •-•fJ _ .. ..................... ' ..................... --------- -•------•---•-------•-•-----• ------------------- .................................. -••--- ! ..........................................I •-•---...-••--------• ---------- ---- ik r__ ! _ __F - [Draw existi�n90d,4qu+red addition on reverse side) NT- I t I hereby certify that 1 have prepared this application and !that the work will be done in accordance with San Joaquin CountyOrdinances State Laws and Rules es and Regulations of the San Joaquin Local Health 'District. Horne owner or licen- sed agents signature certifies the following: I certify that in the perfornsonce 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 Comensat on laws o California.'"' P r; Signed ---------- ----------- • -------- - ---- --- _- ---•----------------------------- Owner BY ....... .. Title (if of r than owner). O DE USE ONLY APPLICATION ACCEPTED 13Y - ...... DATE ..... BUILDING PERMIT ISSUED ........ ................................................• • DATE ............................ ADDITIONAL COMMENTS .............. .. . .. r �, . ".t?�•:... �_ • ---••••- - • k.--•---------••-••-•••---•------•••-•----•-----•------•-••--•••------••- ---••---•--••--•----_--•........ ..... ...... • . -v� Final Inspection by: __ Date .. .l... y ` a SAN .JOAQUIN LOCAL HEALTH DISTRICT E. H.13 241-'66 Rev, 5M 7/72 3,M I