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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 3 ---- ------ y�r Permit No. --- `-77---. P p - ,.�. (Com lete in Triplicate) 3 3 � �--�, -C "°_ This Permit Expires 1 Year From Date Issued Date Issued -------------- Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein t described. This application i's made-�in compliance- with County,Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ------�_- _ _ ; .'.!_(/ _:-- --------- ......---.:- ,_..- -----CENSUS TRACT -------------------------- Owner's - - Owner's Name m _ Phone ------ Address------------- --------------------------- Y = ----------- ---•---•------ Contractor's Name ---------__..____ t Phone -------•=-------------------------------------------------•-=-------.License # ��------ --�---- hip Installation will serve: ResidenceApartment Nouse❑ Commercial ❑Trailer Court Motel ❑ Other -------------------------- ----------=------ r Number of livingunits:.__ t,Size - g �, ��---- --- _ Number of bedrooms _____--_-.--Garbo a Grinder- Lo+,- Water Supply; Public System and name ____________________ 7. ________Private �— Character of soil to a depth of 3.feet:f Sand'❑ Silt❑ ' Clay ❑ ' Peat❑T. "Sandy l oam ❑; Clay Loam ❑ # Hardpan ❑ Adobe ORIFill 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.) w A .. , NEW INSTALLATION: {No septic tank or seepage pit permitted if public sewer is available within 200 feet,] � si PACKAGE TREATMENT [ ] SEPTIC TANK,[ ] Size________ X`�� _ Liquid Depth ---_�±�-__�_____________ Capacity -��7llrlc_ Type ____________________ Material- ........ -_-- No. Compartments ------- ... .... to' nearest: Weil ______� _ _ _-__ GD ___-_ --------- Distance \1 � � Foundation : : Prop. Line LEACHING LINE [ ] No. of Lines ________1_____ _________ Length of each line---------/(,to-__ Total Length - ----- 'D' Box _.__ Type Filter Material%F%_ _____/.&4�epth Filter Material -------_______ ., Distance to newest: Well --- Uq Foundation �� r1�l_ Property Line SEEPAGE PIT [ ] Depth '-- -------- Deter 3-�(`6---- Number -------------I---------.--- Rock Filled Yes No �❑ Water Table Depth ----------Q-CI- 15-------------------------Rock Size --/--� jj----------- Distance - - / Distance to nearest: Well _______?W-6441e-��___---_Foundation L�_ __ - ! Prop. Line ....5 _ REPAIR/ADDITION(Prev. Sanitation Permit+ --------•-------= ----------------- Date ----------------------------------) Septic Tank (Specify Requirements) ----------------------------- •----------- ---- --------------------------------- �- ------ Disposal Field (Specify Requirements) ,� ��2< �%��'� '► ------------ --4------=------------------------------------------------------------------------ - -------- --- ---------------- ------ --- --------------------------------------- ------- + (Draw existing and-required addition on reverse side) � .Irhereby certify that V.have prepared this-application and thatahe work-w"iII-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 vYhich this permit is issued, I shall not employ any person in such manner as to become subject tq Workman's Compensationlaws.of California:" Signed Own er -------- By _ E � •------------------------ -Title --- ---- ------------------------ ----------------------------- (If -------------------- --(If other than-'ownerf.i ; FOR;DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----------- ----- - --------------------------------- ------------_---------•----- ------ DATE ` 7 Z - ---------------------- - ------------------------ BUILDING PERMIT ISSUED - / ` - -- §; ---A� ---- ------ --------- - - ----- 3 / f/� .---A t�o----- d!Y ADDITIONAL COMMENTS ;` 4 _ > 3 �� P -------------------------- --------------- -- - ---- --- -- -- - --- - // - ZOO s - --- -- -- Final Inspection by: P - --- ----------. ------c% ----------- SAN JOAQUIN LOCAL HEALTH DISTRICT � E. H. 9 1-'68 Rev. 5M