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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. 70 —�i Z-s ________________ This Permit Expires i 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 County O�dinance No 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .erl©,dol-__die---- -- -, __-- _ -- -------CENSUS TRACT _�'�_____________•- ------------- a r � -• Owner's Name --- --------------------------------------- -------Phone-------------------------- ------ Address -Q �c �l City ------- ---/� ------------------------------ Contractor's Name ---- License #/ - 3 -Y_____ Phone ------------- Irrstaflation will serve: Reside a [Apartment House❑ Commercial:❑Trailer Court ❑ Motel ❑ Other -- - - ---------------------------------- Number of living units:-------+*--- Number of bedrooms __3___.__Garba_ge Grinder ------------ Lot Size ___ ____________________ _>--—_______ Water Supply: Public System and name -------------------------------- •-- ---------------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam 2�' 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.) O NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) � PACKAGE TREATMENT [ ] SEPTIC TANK[ 7 Size----------------------------------- ____________ Liquid Depth -___---_-__....__.__...._- Capacity ----------- -------- Type -------------------- Material---------------------- No. Compartments ---------.---•- Distance to nearest: Well ------------------------------------Foundation,--------------------- Prop. Line ---------------- ._._-- LEACHING LINE No. of Lines _________________ ----- Length of eachline---------------------.------ Total Length ___________-_______._..____. 'D' Box ------------ Type Filter Material --------------------Depth Filter Material --------------------•------------------------ Distance -------------:--.._...Distance to nearest: Well ------------------------ Foundation ________________________ Property Line _-..__-._-...._._....... SEEPAGE PIT [ ] Depth -------------------- Diameter ------------------ Number ---------------------------- Rock Filled Yes ❑ No I❑ Water Table Depth -------------------------------=----------------Rock Size ------------------------------- Distance to nearest: Well _____ ---------------------------------- -------------------- Prop. Line ............ . REPAIR/ADDITION(Prev. Sanitation Permit# ____________________________________________ Date __________________________________) Septic Tank (Specify Requirements) ---------------;----- -----------------§------------------------------------------•-------- • ----- -- Disposal Field {Specify Requirements) -- - --- - ------------- `-Y ( �i ------------------------ ----------------------------------------------------------------------------- --------------------------------------------------------------------------------------------- (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 thot in the performance of the work for which this permit is issued, I shall not employ any person in such manner ash o become subject to Workman's Compensation laws of California." Signed ------------------ --Ntion ---------------- ---- ---------------•--. Owner R ------ Title BY � - (If othowner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----- - -- - ---------------•------ ---------------------------------• HATE l '27------------------- BUILDINGPERMIT ISSUED ----------------------------------------------------------------------------------------------------------DATE ------------------------------------------- ADDITIONAL COMMENTS ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------t ---- -- - -------------------------------------------__________________________________�_ _ ___ ____________h__---_ _ __ __Final Ins ection bDate __-_____. __ ,T___ ____ P Y -- --- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M