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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No.�l— - - ----`3r--r --- ----------- -- ----------------•--------------------- (Complete in Triplicate) II --- ------------------------------------- --------------- Date Issued �l- ' 71". -- This Permit Expires 1 Year From 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 Ordinance No. 549 and existing Rules and Regulations: I JOB ADDRESS/LOCATION •, i - ------ 9 - CENSUS TRACT ! .• -----.Phone Owner's Name --r`%K � /G� --------• . City --- -------•---- Address --------- ----- ' -- - Contractor's Name .--.------ - ``�- - - ------- tL7-.License # 4eU;J_gF Phone --------------------------- Installation will serve: Resident 2r/Apartment House❑ Commercial :❑Trailer Court IMotel ❑ Other ------ ---------------------------------- ---- N ! -------------------- Number of living units:- -_�- Urmber of bedrooms _"�"___""Garbage Grinder --__"__-____ Lot Size _-"_-_"-__"---_ - Private Water Supply: Public System and name ----------------- --- ---------------- --------------------------------- F - - I Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loom [] 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 tank or seepage pit permitted if public sewer is available within 200 feet,) V IC TANK ---- Liquid uid De th ------------------------- PACKAGE TREATMENT { l � [ , ----- - --Size-- Material__---------- ---------- --------- -- q p L3 Capacity _ Type _ _--_--""_---------- No. Compartments Di santeI -Found ------- --ation ---------------------- Prop. Line -- to nearest: Wel{ ------ ---------- ------------- - LEACHING LINE [ ] No, of Lines ___-__-- `---------- Length of each line------ --------------------- Total Length ----------- ---------------- J Depth_- Filter Material _.---_----__ \ 'D' Box "--�_".-___ Type Filter Material _"--__-_"_______ Distance to nearest: .Well --"_" _ "-------- Foundation -_--------------------- Property Line _________----------•_-- { . SEEPAGE PIT [ ] Depth Diameter ---------------- Number .--------------------------- Rock Filled Yes ❑ No Q I Water Table Depth --------------------------------------------- Roc Size " - i_ ;Distance to nearest: Well -----Foundation -------------------- Prop. Line ------ •------•-- "SD REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ------------------- ) Septic Tank (Specify Req(iirements) - - ------ ------------------- -- ---------- ------- ----------- ------- - - - ------------- Disposal Field (5'pecify Requirement --- 4 _ ----- ---- -- = ----------------------------------- ------------------------------------------ Draw existing and required addition on reverse side) �� --- --- -^ nce with San Joaquin I hereby iertify that I have prepared this applios cation and that the work will be done in accords q 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: f "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 Workman s Compensation laws of California. - ----------- __t" Owne � Signed �: _ - - -- -7 �BY ----------- -- t e �' Ti -- -------- -------- -- - (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---------- "---` --- ----- -- - --------------------- -----. DATE "6.� " - -------- -----DAT -------------------------------------------- BUILDINGPERMIT ISSUED ----------'--------------- --------------------------------------------------------------- ADDITIONALCOMMENTS ----- ---- --------------------------•------------------------------------------------------------------------------------------------------------•-----;- ----------------------- Dcit4l, ' Final Inspection b I SAN JOAQUIN LOCAL HEALTH DISTRICT i E. H. 9 1-'68 Rev. 5M