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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT� --------- -- ----- Permit No. (Complete in Triplicate) K"70,.3 ---------------------------- ____________________________ 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 complian with County,Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/L A N /OO / --------------------------------------------CENSUS TRACT -------------------------- Owner's Name ------- --------------------------------------------- -------------------Phone Address --- ------------ © � --- - ------- - --- City ---------------- -- -------------------------------- ...................... - yy Contractor's Name _-_e_01. _ _ _ �_____.License #�CI- 3 — Phone -------- ..................... r Installation will serve. Reside ce Apartment House❑ Commercial ❑Trailer Court ❑ I Motel ❑Other -- ------------ ---------------- Number of livingunits:__.-_____ Number of bedrooms _Garbage Grinder ------------ Lot Size ______________________ _�____/____._. Water Supply: Public System and name --------------------------------------------------------------------------------------------------------------Private C Character of soil to a depth of 3 feet: ' Sand❑ ilt E] Gay ❑ Peat E] - Sandy Loam.,❑�Clay Loam ❑ Hardpan Adobe ❑ Fill Materiel ------------ 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 see ge pit permitted if public sewer is available within 200 feet) O 'I r PACKAGE TREATMENT [ I SEPTIC TANK Size't�___,1r__�___�' .-.�r__�.------------ Liquid Depth _ ____________________ p, Capacity 0�-- - - Type _ _ _ _ ___ Material.4 No. Compartments -- --..._...._. V t �f�-w-.-- O / Q Distance to nears Well - __---___-AW________�`____Foundation ____-_1_____________ Prop. Line ________"___. LEACHING LINE [ No. 'of Lines __,__:r --------- Length of each line_______---- _______ Total Length4.�_____________ o� 'D' Box ---- ------- Type Filter Material ------ _ -_Depth Filter Material __r_____1.9------------------------------- r . i Distance t nearest: Well _.------ Foundation lV -___-_____"_ Property Line __________ ___ ,o SEEPAGE PI [ Depth ------- __- Diameter -__ ___.------- Number __________ Rock Filled Yes No i❑ Water Table Depth ---- ------------------• ---Rock Size� --------------------------- Distance to nearest: Well ---------------td --_____-Foundation ----/V r-...'__ Prop. Line ...... REPAIRJADDITION(Prey. Sanitation Permit# ------_-------------------------____________ Date __________________________________) Septic Tank (Specify Requirements) ------------------------------------------------------------------------------------------------------------------------------------------ r Disposal Field (Specify Requirements) ------------ --------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------- (Draw existing and required addition on reverse side) I hereby certify that 1 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 tha ' the performance of the work for which this permit is issued, I shall not employ any person in such manner as to becom su ct to Workman's Compensation laws of California." Signed ------- Owner BY ------ --- ., Title -- -------------------------------------- If other than owner} FOR DEPARTMENT USE ONL APPLICATION ACCEPTED BY --------------------------------- ----------K ------------- ----------------- DATE - ~4f-------- - BUILDING PERM __ __ __ IT ISSUED __;T-------------------- -------------------- DATE -------------- ADDITIONAL COMMENTSh---------=--------------------- --- -- -- ----- ---- ------r-------- ----- ---- ------------------ ------ -- ------- ---------=------- ----------------- --- Final Ins ection b Date __- ___P Y ------------------- ----------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M