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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT a (Complete in Triplicate) WARNED- 3 - ..--------_-- ----- - - This Permit Expires 1 Year From Date Issued Date Issued ./..0-1. --- 7� 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 -- -_!_/..Gt.flY__srr_A_'16 -.- ------ - /�o�( ----------..--C-E-NSUS TRACT ._.-...-....-_ Owner's Name . - _ ` Address � O .----_---- - ---------------------- - - Phone ------- ----------------------- - --- � --------- - . City L� - - - ---'--------'------ Contractor's Name -----------------------------------------------_----------------........License # ..._.-..---------.._.. Phone Installation will serve: Residence [ Apartment House❑ Commercial ❑Trailer Court I❑ Motel ❑ Other ---.--__--- . ..------------------ ------ �� Number of living units:_-__._ Number of bedrooms 3....__Garbage Grinder ____.._ Lot Size op_!'5Q_� ...___.....y__-.-_.... Water Supply: Public System and name .----------...---------------------------......----------------------------------------------------PrivateA Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material ______ If yes, type ._________-_...._.. r 7 (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) T_ NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) e J PACKAGE TREATMENT [ ] SEPTIC TANK;Q(] Size_-..I-:�.'r.�_3-_'r_•+�.�_____ Liquid Depth ...r.____...._._..... �3 Capacity Ad_0 Type ' .._ Material.__ No. Compartments z-.................. G Distance to nearest: Well _ ._.Sb..__..____._..Foundation __46--------------- Prop. Line ..�.............. � LEACHING LINE A] No, of Lines _-..3____----- .. Length offeach line....�f11.___.._.._--- Total Length ---/A_a.............�7 'D' Box C6ype Filter Material NJ�--'._._....Depth Filter Material _1f................................. Distance to nearest: Well l0_' ----------- Foundation .../0----- ------- Property Line ._i�----.___..__ - SEEPAGE PIT Depth __��_ -___. Diameter 3-q------- Number ------3_-_.__.-_.__. Rock Filled Ye:� No C1Water Table Depth ..._/_ __--------------------------------Rock Size --------------- Distance to nearest: Well -------------_mm--------Foundation 10 ------ Prop. Line -------------- REPAIR/ADDITION(Prev. Sanitation Permit# ........-----------__.._._..-------_------ Date -----_-------- ... ..........__. Septic Tank (Specify Requirements) ----------------------.-.--_--- -_---- Disposal Field (Specify Requirements) ----------_-- ----------------- -------------------------...------------------------------------------------------------------------------...----------------------------------- -----------------... (Draw existing and required addition on reverse side) 1 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 Workman's Compensation laws of California." Signed -- -- ----------------<- Owner - - - -- . By (If other t an owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - ..roc ya�1`------------------_ --- ---- ------------ ----- ----- DATE _/0 •� - BUILDINGPERMIT ISSUED ---------------- ------------------- ............------- ---------------------------------DATE ..... ---------------------------------- ADDITIONALCOMMENTS ----- ------ --- ----- ---- -------------------------------------------------- - -------- ----------- ------------- --- -------------- ---------- ----------------- ----- -------- -- - - - ---------------------------------------------- - v -�3 Final Inspection b j P Y - - - - - - - - - -----Date - - T� ------ SAN - - SAN JOAQUIN LOCAL HEALTH DISTRICT WD E. H. 9 1-'68 Rev. 5M