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FOR OFFICE USE: _ .. . . APPLICATION FOR SANITATION PERMIT .. . ..._-•-•-• . ._ 4, ......... IComplete in Triplicate) Permit No. ......... .......... ................... . ..................... This permit Expires t Year From Date Issued Date Issued .....�........... Application is hereby made to the San Joaquin Local Health District for a permit to construe► and Install the work herein described. This application is made in compliance Wiffi County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .6... ... '.. f. .... L�� ' � ...CENSUS TRACT ................ Owner's Name . . . .. 1 _?�- y................ . .... ..... ..... .................:........, ......Rhone ..... ... ... ., AddressCity .. ............... . ... ....... .. 4 Contractor's Name - - --- - C"•rYi .... ..........License # , .��.. .�. 'f� Phonef '! ,,�., . r Installation will serve: Rosi encs❑Apartment M seg Commercial OTrollor Court l] Motel Q Other ............................................ Number of living units....-./ Number of bedrooms ,� Garbage Grinder Lot Size Water Supply: Public System and name ..............................................................................................................Private Q Character of soil to a depth of 3 feet: Sand Q Silt Q Clay Q Peat Q Sandy Loom 0 Clay Loam Q Hardpan Q Adobe Q 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 I ] Size................................................ Liquid Depth .......................... Capacity -------------------- Type .............-...... Material...................... No. Compartments ...................... Distance to nearest: Well Foundation ...................... Prop. Line ...................... ._I LEACHING LINE ( ] No. of linesI.....:_.__......_. length of each line.... j�............... Total Length ..Pi--.................. D' Box Type Filter Material Depth Fitter Material ............................................ d. Distance to nearest; Well ........_ .......1.. Foundation ..... .............. ... Property Line ........................ SEEPAGE PIT ( j Depth -- - ........ Diameter _�J...... Number ...... .................. Rock Filled Yes No Q Water Table Depth ..........Rock Size ................................ Distance to nearest: Well .............................Foundation --- ................ Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ........ ..........._.........-..-.-...... Date .................................. N 0 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 Neagh District. Nonce owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit Is issued, t shall not employ any person In such manner as to become subject to Workman's Compensation laws of California." Signed __.. ......--•-••- Owner By _.... �Ia.... .... Sitle ........ . .. _.----- -- ....... .. (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY / _... . . :. ........ .. .. ........... DATE 7 �4! BUILDING PERMIT ISSUED -......................... ...... . DATE ADDITIONALCOMMENTS -----------------.............................................................-...---_ ..--.......................... ........................................ . -- --------- -- --•-•-_..._. -...__........,__...,_.. Final Inspection b : .., ,.. �iV Date .. ��z-� 1 . 13 `68 Rev. SAN JOAQUIN LOCAL HEALTH DISTRICT 8/71j 3M