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FOR OFFICE USE.. ...................................�� .. .... APPLICATION FOR SANITATION PERMIT Permit No7S..:.l..�--� (Complete in Triplicate) . r l.�.:�j ......................................................... This:Permit Expires t Year From Date Issued Date Issued :..D 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 OrdincInce No. 549. and existing Rules and Regulations: JOB ADDRESS/LOCATION /6 .......CENSUS TRACT .._.. Owner's Name 66 t� 14- _. _ _,.._.._ ... .... Phone .... ........... ..._. Address .-. .__............. 1t- _-_....._... ..City Contractor's Name ............. � license# }. -r6aT .......... � 3..... Phone .........•............ ....... Installation will serve: Residence Apartment House l❑ Commercial❑Trailer Court J Motel❑Other........................................... r Number of living units:...... -. Number of bedrooms .........Garbage Grinder ....... _ Lot Size .....,�d.. ....�.z ............ Water Supply: Public System and name .............................._............-----...._....... ...r. -p!`e-`.`..................Private Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay ❑ Peat❑ Sandy Loam 0 Clay Loam Hardpan❑ Adobe Fill Materlal ............if yes,type............... ............ (Piot 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 .......................... a Capacity ----------------•--- Type .................... Material.........._........... No. Compartments ...................... 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 ................................ 6 Distance to nearest: Well ........................................Foundation .................... Prop. Line ...................... REPAIR/ADDITION(Prov. Sanitation Permit# ............................................ Date ..................................) Septic Tank (Specify Requirements) ............. ................... Disposal Field (Specify Requirements) .. •-- Z ....0.l.......Q.... ....................................... .. ............. --•-- `-�/ ---- - ...---•-•--....----•----•--------- ----------------- •--•----•----•------------•-•-•-----••---•-----•-•-•--••----•........•••----•-----•-•..._............_..•••••••••---................._......... (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 Son Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local HealthDistrict. Name owner or licen- sed agents signature certifies the fallowing: "I certify that in the performance of the work for which this permit is issued, I shed not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ----- - Owner BY ... title :.. Com''/ (If other th n owner FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY . _ ....._... 3 DATE BUILDINGPERMIT ISSUED - ----------- --- ------ ---- ---------- .................................. -----------................DATE .. -- --.'........•--•••---... •-••••-- ADDITIONAL COMMENTS ---- ------- -----• --------.- ,... - ------------ -----_..._..--------..... -------------------------------------------------....._._... ------------ - Final Inspection by .. � . ........ ...--.. Date { EH 13 24 1-68 �2 ev. `SAN JOAQ IN LOCAL HEALTH DISTRICT ?� 3M , :