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CD A FOR OFFICE USE: - APPLICATION FOR SANITATION PERMIT Permit No: -3 �y (Complete in Triplicate) ---------- -------- --------- --------------------- 3 Date issued --6-��__--�--. - --------------_-------- ----. This Permit Expires i Year From Bate Issued Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is made in compliance�.Nith County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS LOCA N .__.---_____ i l __._ .._- -:----CENSUS TRACT ----- ------------------ Owner's Name _ Phone -----------------•----------- ------------- --------------- --- - ? Address �l �i-G`�-Y `'�`"-``-rC� l ity ------------------------------------------------------------------------- i Contractor's Name ----- - --- ---E— ------ --- L 4Lu_-_-- .License # /E�:_3��Phone -------------------- Installation will serve: Residence Apartment House❑ Commercial :❑Trailer Court ',❑ Motel ❑ Other --------------------------------- ---------- Number ----- --Number of living units:------l----- Number of bedrooms ___7?�Garbage 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.F] 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 flank or seepage pit permitted if public sewer is available within 200 feet,) L) PACKAGE TREATMENT [ SEPTIC TANK'[ ] Size-----------------:------------------------------ Liquid Depth -------------------.------ -- C Capacity -- `---------------- Type -------------------- Material------%------------ No. Compartments ---------•--------•... Distance to nearest: Well ____________________________________Foundation ----------------------- Prop. Line -_------------.-_-__.- LEACHING LINE [ ] No. of Lines ------ Length of each line---------------------------- -Total Length ,-----_-=.-..-----.......... ` 'D' Box ------------ Type Filter Material ----------._.------Depth-Fi-Iter Material-------------------------------__----..---- Distance to nearest: Well ------------------------ Foundation ------------------------ Property Line ______._..------------ SEEPAGE PIT [ ] Depth ----__I------------- Diameter ---------------- Number--------_-------------------- Rock Filled Yes.[-] No i❑ Water Table Depth ------------------------------------------------Rock Size i! -- ----------------f--~- --------- Distance to nearest: Well --------------------------------•-----Foundafon ------ Prop • Line ........... . . REPAIR/ADDITION ...... - (Prev. Sanitation Permit# -------------------------------------------- Date _________----------------------.-) Septic Tank (Specify Requirements) ------------------------ ------------------------------------------•_•• ------------------------- r p- -- ------- ---- --- -- isposal Field {Specify R quirements) --- ------------ � i ��`` ' Ze ------------ Zr - -- = -:. { q (Draw existing and re uir 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 Workma 's Compensation laws of California." Signed -------- ------------- ------- � Owner �, '` - ` Title --------- / - u-- ��. - (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _. P__ DATE ------ -- - -------------------------- ------------------------------------------------ BUILDING PERMIT ISSUED ------- -'------- ------------ -------------------- ----------------------------------DATE -------- ---------------- -••--- ADDITIONALCOMMENTS --------------------- -------------------------------------------------------------------------------------------- ----------i:---------------------I------- --- -------------- ---------------------- - - --- ------------------------------- -------------------------------------------------------------------- ------- ------ --- - ------- ---- --- ------- --- r Final Inspection by: ---- Date SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M i