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FOR OFFICE USE:` APPLICATION FOR SANITATION PERMIT Permit No. -� -3.33 -.. (Complete in 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 CountyQrdinan No.,549 nd existing Rules and Regulations: pp pJ �,e�NV �e JOB ADDRESS/LOCATION -.e -. _ x. -- '�" ---��"E---CENSUS TRACT -_ _Owner's Name .- -- �-----------------------------=--------------- -------------- ------Phone --T,3--3_5'7.7..--• ! Address .J - y� � -- , `1 ------------------------ City -" 'C r `:-------------------•------------------------ Contractor's Name # _oC.�+-J � ---- Phone Installation will serve: Rest"denteW Apartment House f] Commercial ❑Trailer Court ;❑ Motel ❑Other -------------------------------------------- Number of living units:.-- ------ Number of bedrooms _-_3------Garbage Grinder -__Er'- --- Lot Size ---_-__._-___ Water Supply: Public System and name ----------------------•-----------_-_-------------------------------------------------------------------------Private;V 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 seepa it permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK Size---- _- _ -�t`- ---------------- Liquid Depth ...... f Capacity ---_l2,v0---- Type -ALcrAr(t-- Material_ No. Compartments .............. stance to nearest: Well ..--___f_ •• ' --------------- -----Foundation ---�-�---- ----- Prop. Line ---•--'ate-----------...-- LEACHING LINE �o. of Lines ---3---_------------- Length of each line......7a_---------------- Total Length __ _L4-----__.- 'D' Box .>Lcc.__ Type Filter Material J?A6r-----Depth Filter Material ----- _-._---_-__--_ Distance to nearest: Well --76--------------- Foundation -------------- Property Line --__ ---------- PIT [ ] Depth -------------------- Diameter ---------------- Number ------------------------..--- Rock Filled Yes ❑ No C] WaterTable Depth ------------------------------------------------Rock Size ----------------- ------ Distance to nearest; Well ----------------------------------------Foundation --------------- Prop. Line ----------- ...... REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------) SepticTank (Specify Requirements) --------------------- ------------------------------------------------------------ -------------------------------------------------------- Disposal Field (Specify Requirements) --------------------------------------------------------------------------------- -------------------------------------------- f -__7 ------ - --------- -•�_�-JCJ--_---- �7G�G!!+!_ - --_1-------------_------------------•-r---------------------------------------- ----------- - - - (Draw existing and required ation 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. Hone owner or licen- sed agents signature certifies the following: v "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 suWect to Workman's Compere ation laws of California." t + Signed -------------- FOR Owner By ---- - -'tst� - RTMTitle ------- - --------- (If other than owner) !° DEPAENT USE ONLY APPLICATION ACCEPTED BY -------t--__- R--0--------------------------------------------------------------------- ----- DATE ------- ` ` - (----------- BUILDINGPERMIT ISSUED -------------------------------------------------------------- ------DATE ------------------------------------------- ADDITIONAL COMMENTS ------------ --------------------------- `� �. /F 117 f3 '-. 'J�-STRKF -------ICN)?-- ----------------------------------------- --- - -- -- ------ -- -------- --- - - -- ------------------------------------------------------------ -------- Final Ins ---- -Date --------- --- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M