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i FOR OFFICE USE. APPLICATION FOR SANITATION PERMIT �3-� 7s�9 ..........:...... ................................... . (Complete in Triplicate) Permit No. ............. --•---• ---------------- ---- '..-. pp�� 1 ->---: This Permit Expires 1-Year!F one Date Issued Date Issued ,.jr 4 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/LOCATION ...... �� Sp -I�(�Ci;-C.��._ .P-�.��_.._.��...............CENSUS TRACT :......................... Owner's Name �E {_._. Y.1 '�`-._._ _.._...... `�' ....--- ................. Phone .. .x-?-�'/. Address - .......................................--•••--- ....... - : .. ..................."'•.--....__,�.. sZ..,...._.._..__.,._..._......._.__._._..__. City -•--. ..�� Contractor's Name {�{}R(-Lts Hf e s rsi . dUe-.-...license #a��.`f3. - ..... Phone Installation will serve:; 4 Residence [Apartment House f-] Commercial ❑Trailer Court C Motel O Other-1 ......... .� t I Number of living units:......... Number of bedrooms ..3------Garbage Grinder ............ Lot Size ............................................ Water;Supply: Public Systern and name ------..'...........------...........'i_...--------------.-_._...____......__.___._._....___.._._.._..._......Private Character of soil to a depth•of 3 feet: Sand E3 Silt E] Clay ElPeat❑ Sandy Loam C] Clay Loam 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,) PACKAGE TREATMENT SEPTIC TANK4 Size------ ............ Liquid Depth r .r.�. ..... pacify ./?v?a Type Material..._ _ %c.v ? No. Compartments __ .........:.... Distance to nearest: Well . _...6............_'..._.._..__-.Foundation Prop. Line .... � LEACHING LINE [ ] No. of Lines . __ _ .._ . Length of each line ......�� . g 6 .. .. ..._..__... Total Length __.��Q.............:. S 'D' Box Type Filter Material .. ._... .....Depth Filter Material ....1 .ef.._._._.... I—........ Distance to nearest: Well _....v ?'_..' .. Foundation .......(P.,t'....... Property Line ......... N " SEEPAGE PIT [ J Depth .. ..__._....__.... ❑ ❑ - _ Diameter Number ................ ........... Rock Filled Yes No Water Table Depth __.................................. ..........Rock Size .......................... Aq Distance to nearest: Well ........................................Foundation .-•-----.... ....... Prop. Line ..................-C REPAIR/ADDITION(Prev. Sanitation Permit# ------------------------- ... Date .................................. l rO Septic Tank [Specify Requirements) ................... ..........................................-............................_____--.-----.--- Disposal Field (Specify 'Requirements) ------------------------------------------- -------- ------_..........:-..................................................... . ----- ----------....._._._. ------ II --- ... ---- . _. ---- •----- ----- .__..----------------•-- ....................... --...------.....--- ------....._...... . II ........ .............. ----------------- .......... ----.--.....----..._.....---- ------•-----......--•------------ (Draw existing and required addition on reverse side) U hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin [aunty 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, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." h' �i Signed i. .. . .. .. Owner - ...... .......... ............ Title l!'.,..---.........._.......... (if other than owner FOR DEPARTMENT U E O APPLICATION ACCEPTED BY ................_.. .._....._. ...........,.. ....... DATE ._.. ..� ..` ..._....--...._...____. BUILDING PERMIT ISSUED -- ..... .......... . .. -----__.......DATE .-----.- .. ADDITIONALCOMMENTS ----------- ------ ---------------- ----------- --- -------__.....--- - ........................I............ '---------------- ----------- -------------- ------ ---•--------------_._... -----__._._.-•---_...._...._... -----.._...------.._.....-----..._._...... -•-........ I -•---•---- ------• -----------------------•-.-----------•----._.._...-----....----...------...._.---------._....__---------- ...----------........................._....... Final Inspection by: •........................._....__.._._-_._:. .. ------------- ---- _..... ......._.._. Date iw SAN JOAQUIN LOCAL HEALTH D ICT I E. H 7/72 3 H. L3 24 1.'68 Rev 5M - —- - - `