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f FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ------------------ - (Complete in Triplicate) Permit No. __ _- --------- �. " _______________________--------------- --------------- This Perm it'Eicpires 1 Year From Date Issued Date Issued _ 3- . __x__70 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 Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATE -----�-------0-- -----------�"�Ir �---9V}, vi ---------- -----------CENSUS TRACT ------------------ Owner's -- - - • ••-•-Owner's Name ------ -- ------ -- --------- ------- -- ----- ------------------- ---- ------ --------Phone -So3 _----- -- 3 Address City Contractor's Name -_- . v` _____________License.#/f,*S7:(_____ Phone _� d- Q. Installation will serve: Residence XApartment House-E] Commercial :❑Trailer Court ❑ Motel E]Other --------------------------------------------- �' ,r9 tuber of living units:.__-_---- Number of bedrooms ___3____Garbage Grinder __`_.___. Lot Size _ _________________ _____________ Number /7 Water Supply. Public System and name --------------------------------------------------------------------------- --------------------------------Privatex Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑, .'Sandy Loam '[] Clay Loam .E] Hardpan ❑ AdobeFill Material __._ " If yes, type ___________._._________ v S (Plot plan, showing size of'lot�Eocation of system in relation to wellsbuildings, etc. must be placed on reverse side.} NEW INSTALLATION: •.tjL { " -�_- , _ _ - __ - NEW septic fbn'k or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPT IC,T.ANK [ ] Size-------------------------- ---------- Liquid Depth -------------------------- Capacity -�------------------ Type -------------------- Material---------------------- No. Compartments ----------- ,...-.Distance to`near60. Well ------------------------------------Foundation --------------------- Prop. Line ----- ---------- LEACHING LINE [ ] No. of Lines ________ ______________ Length of reach line F___._____:__.___`_.______ Total Length -----------•-___.._.._____-. p� k 'D' Box ------------ Type Filter Material --------------------Depth Filterf Material ------------------------------------ Distance _____-___- ---___- s Distance to nearest: Weil ________________________ Foundation _._____.____.__-___ Property Line -----------------•...... SEEPAGE PIT Depth -------------------- Diameter ---------------- Number -------.-------------------- hock Filled Yes .0 No 0 r Water Table Depth -------- =--------------------------------------Rock Size -- }----------------- ----- --- ,� = Distonce-`to nearest: Well _:__-_____:-- :----------------------------Foundation-I_------------------ Prop. Line -----------------__-- *ffAJR/A"T40 '(Prey:-Sanitati.on Permit# -------------------------------------------- Date --------.-------------------------) Septic Tank`(Specify Requirements] ---------------------------------------------------- --------------------------- Disposal Field (Specify Requ' ements} �/ ---- --------- --- --------------------------------------- --------- Y/ f - r --------------------------------------------- ---- - - ------------------ ---`- -:-` ----------------------------------------- (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: 1 "I certifyTth*'i'hw•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.7— Signed --- ------------------ - -- Owner , BY ------- - ----F Title -------------�1 ---------- er than owner) FOR RTMENT USE ONLY APPLICATION ACCEPTED B DATE. BUILDING PERMIT ISSUED DATE 3 ---------------- - -- --------------------------------------------------------------------DATE ------------- ----------------------------- ADDITIONAL COMMENTS -------------------------- -------------------------- ---------------------'-------------- ----------------------------------- ----------------L-------------------------------------------------------- -------------------------------- ----------------- ------- ----------------------- --- - ------ --------------------------------- -- --- -- - ------ --------------- } --- ------------ Final Inspection by: ----------- -------------------------------------------------------Date r--lam a ----------- -- SAN AQU1N LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M "�'