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FOR OFFICE USE:-;70 APPLICATION FOR SANITATION PERMIT s ------------------- -------- -----,---------'- (Complete in Triplicate) ----- ., Permit No. .7.0_----- -----G_ ---- _ _ _ _ _ ---- - ---- / Date Issued _7__ V-70 � '� - -- -__ -__ -_ \,/--__-.-__-___ ___ __-- This Permit Expires t 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 ADDRESS/LOCATIO -------- --- CENSUS TRACT - Owner's Name --4 ;Olt�� f. ^'• * Phone !��' .. Address ''fid sa�._ �,�. • 1-1'�_``f - --- --- ------ City -- --------- Contractor's Name Ci-- --------------------License # �SZ17--- - Phone '` Installation will serve: Residence WApartment House❑ Commercial ❑Trailer Court i❑ Motel ❑Other -------------------------------------------- Number of living units:-/----- Number of bedrooms __99_-...Garbage Grindero;�P__ 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 ❑ AdobeX 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 [ ] SEPTIC TANK:[ ] Size------------------------------------------------ Liquid Depth _______.__.._._-------_. 10 Capacity -------------------- Type -------------------- Material---------------------- No. Compartments ----- •-------_-•--- Q+ Distance to nearest: Well _________________-____-__-..___-Foundation ---------------------- Prop. Line ________________--___ LEACHING LINE [ ] No. of Lines ------------------------ Length of each line---------------------------- Total Length ,____-___-_--------------- 'D' Box ------------ Type Filter Material ____________________Depth Filter Material ______-________-____._____---------_..__--.- Distance to nearest: Well ________________________ Foundation __---------------------- Property Line _______._-_-___---.-__ SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number .--------------------------- Rock Filled Yes ❑ No 0 Water Table Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well -----------------------------------------Foundation -------------------- Prop. Line _..................... REPAIR/ADDITION(Prev. Sanitation Permit# -----------------_------------------------- Date --------------------______________) Septic Tank (Specify Requirements) ------------------ -------- -- -------------------- --------------r _ Dispos I Field (S )ecify Require encs) ----------------------------- ------ ----------------------------------------- -------- ---------------------------------------------------- (Draw existing and required addition on reverse side) I hereby certify that 1 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 parson in such manner as to bec ubject to W rn k- n's Comp*nsation laws of California." Signed --- =�`� Owner BYTitle ------------- --------------------------------------- ---------- (If other than owner) 4' ARTMENT USE ONLY ry APPLICATION ACCEPTED BY . ------------------ ---------------------------. DATE ---- 7l �_ r,/= d-------- -------- BUILDING PERMIT ISSUED -------- --------- --------------------------------- ----------------- -------DATE ADDITIONALCOMME 1 - 1�-+-�j ----- - - - ---- ---------------------------------------------------------------------------------�-----_--------------- ----------- ------------------------------------------------------- --------•- ------------------------------------ -----------------------------------------f ------------------------ -- - - ------------------------------------------------------------------------ -- ----------= -••-- Final Inspection by: ---------------- -- - -- -- - - ---------- -------------------------------- ------------------------Date SA AQ LOCAL HEALTH DISTRICT Ur' E. H. 9 1-'68 Rev. 5