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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT " t (Complete in Triplicate] Permit No. .. �- ----------- ..... This Permit Expires f Year rFroin Date Issued Date Issued ./10-i1 .,Y Application is hereby made to the San Joaquin local Health District for a permit to construct and install the work herein I described, This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: I JOB ADDRESS%LOCATION ...�! _S..__..1�%-.•.-_ Owner's Name T E ACT ---- CENSUS TR w •---- ----_. Phone ...._..... Address ...... . .._ ... -----...... � J ......_.:. Cit y - - t........ Contractor's Name . .. �-- �/ ............................................... -r k_..License # .�� f ._ Phone ....................----•-•- - Installation will serve: RespVence Apartment House,[] Commercial ❑Trailer Court ❑ I ) Motel ElOther . ...... ......... ................... Number of living units:..._-.L_. _ Number of bedrooms ._. 3-_.-Garbage Grinder Lot Size _.....1•�'� `-�- Water Supply: Public System and name .............:.... Character of soil to a depth of 3 feet' Sand Private E5 ❑ Silt❑ Clay ❑ -Peat_❑—Sandy Loam Clay Loam C]Hardan _ 1 p ❑ Adobe E] Fill Material .......... If yes, type .................... .... . : [Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be laced 4 NEW INSTALLATION: p on reverse side.) (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK t . Type . ._ . ._ - ..._�. .�•.----'r.---�.....X._��_.... --- Liquid Depth .... _. ._ Capacity P - Size Oa �- •- Yp /�-°�� Material.__�.�.•_ No. Com Compartments tr p Distance to nearest: Well SU._r • ( �••--�•�••-'.--.-""w [� ------------Foundation ...._[_t?...._...._._ Prop. Line E.../._.... LEACHING LINE No. of Lines . ..Y - _. Length of each line-......7- ........ ... Total Length -- 'D' Box .._.. �V Type Filter Material _.__. -- ....Depth Filter Material ..._ Distance to nearest: Well ....._.-.-•� - .............................. ---------•-- Foundation ... •.. .... Property Line r r ' r ----- •--- SHPAP ( Depth }') t I- (__ � .1-�_ Number 6 Rock Filled Yes S' No Water Table Depth ...---_......l�.4�_.'..._. .. �• - --- ---_-Rock Size ..�_'..Lr.f Distance to nearest: Wel! .......------00-0....... ---------Foundation _I-V........ Prop. .Line _fir --------•-_-- REPAIR/ADDITION(Prey. Sanitation Permit# '1 ------------------- Date _.._.. Septic Tank (Specify Requirements), ... .. ---------------------------------------------- u Disposal Field (Specify Requirements) g 1# (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 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 an as to become subject to Workman's Compensation laws of California." P y Y person In such manner Signed .:.. ... ...... Owner, By ._ -------- Title (if other than owner) �- ---- _—--=- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY —� BUILDING PERMIT ISSUED - � .---- . .. .. DATE -�� ©_ .. -------------• ---- ---------. -DATE .. .... - ................TONAL COMMENTS ........................ . � . ---_....------••........................................ inal_Ins Inspection b ----- �..._.:_._ ..._----------•----- ............................... ----------------- ----- ----- . . .._....--- ............----- -- -..---- ----- ---• ----------------- Final Inspection by: ..__� --------Date . �.._r `. ....... ..�G.... SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 1_3 24 1-'68 Rev. 5M .