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APPILICATION FOR SANITATION ? All U FOR OFFICE USE: Permit No. ..7 v • �:._...------ (complete in Triplicate) ............................. (Comp Date Issued .......... ............................................ This Permit Expires t Year From Date Issued ork herein ......... •... _... it to e w Application :s hereby made to the San Joaquin LocalHealthty ordinance District Nom549 d existing Rules and tand all hRegulations: compliance with described. This application is made in comp L ,1 f ._ �,j C 1-. r6m6NSUS TRACT .................... JOB ADDRESS/LOCATION •.... / .........Phone -��w..�-•� �� ... Owner's Name r7.L^G`f � t•• ' .. _ City Address ,) Phone .......- �r 1�' �-- 1/ �Apatment License � ...._...Contractor's NameInstallation will serve: Residence House❑ Commercial ❑Trailer Court fl Motel ❑ Other . ./}_��'.fj._• '��`' �� Number of living units:............ Number of bedrooms ...-------.-Garbage Grinder ............ Lot Size -. ........... Water Supply: Public System and name -----------•------•--•--------------------------------- —......._............... ..........................Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat R— Sandy Loam (3 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 seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ I SEPTIC TANK 1 ] Size................................................ Liquid Depth .......................... Capacity -------------------- Type -------------------- Material---------------------- No. Compartments ...................... Distance to nearest: Well ....................................Foundation ...................... Prop. Line ...................... - LEACHING LINE [ j 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 PITDepth --------------------- Diameter Number ----------- --- Rock Filled Yes E] No C)[ ] Water Table Depth ................................................Rock Size .......................... Distance to nearest: Well ........................................Foundation .................... Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ------- ________ __•• Date _........................... _•_-_-) Septic Tank (Specify Requirements) -._.._.-- .....A.J. �) .... _ ._---•----------------------•------••--- ............... Disposal Field (Specify Re irem9pts) ............................................. . - ------- -�c------ .�._ z....._.. ---------- ---- -------- ----•-•-•-•---•-.----• •.............•-••..---- •-- -------------•-•-----•----••-•-•-•--... . (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 any person in such manner as to become subject to Workman's Compensation laws of California." Signed ...... .......• Owner (If other than owr1 eR DEPARTMENT USE ONLY 3�APPLICATION ACCEPTED BY .-... ... - DATEBUILDING PERMIT ISSUED .......................ADDITIONAL COMMENTS ..... ............... DATE - .... ..---•-••-----._...._..........__. --...._.... ................................_...1._................I....................... . ---.... .......... -•......... ...... ..........•--•••------............. -- ...... ... __ ....._ . ....... ... ...... .......... Final Inspection b - .............. - .._...... I �� EH .....--•- --........Date,�...�--------- -- -- 1J 21� 1-69 `i!ev. S�ii S. .N JOAQUIN LOCAL HEALTH DISTRICT 8/71 3M