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Foil OFFICE USE: APPLICATION FOR SANITATION PERMIT -------------------- �,..._.. _ :.. ----T_ (Complete in Triplicate) Permit No. -�7 f--------------- This Permit Expires 1 Year From Date Issued - Date IssuedR ----- ` � ./-_ _�-/d --------------------------------------------------- Application is hereb. r �� pp y�rnode_lto thg.San Joaquin Loctl Health District for a permit to construct and�in`staII the work herein ,�: . described. This application is made"i'm compliance with County Ordinance No. 549 and existing-Rules and Regulations: JOB ADDRESS/LOCATION ' d s�� l f ----- --- -- -- -------- - ..._.CENSUS TRACT ---------------------- Owner's Name 1U�l l'�------------------- -------- ------ ----------._Phone ------------------------------------ Address - -- 1 Y R . 9 �. .--------t�-------------=--- . Cit � y� , --------------------------------------------- Contractor's-Name 1Contractor's•Name --------------License # -?% _ Phone 3ef+,*_"__A-4 Installation will serve: Residen� J�Apartment House,❑ Commercial :❑Trailer Court ;❑ Motet ❑i0ther ---------------- ------------------------- Number of livin units:"�___._ Number of.bedrooms _;-------Garbage Grinder / 1 Lot Size _ .$` __�;.r _ _________ Water Supply:`PubI c Systemand.name<__-----------_ = -----------------------------------------------------Private, Character of soil:o a depthof3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑I Sandy Loam -❑ Clay Loam ;❑ , Hardpan"❑ Adobe/(� Fill Material ___-#--____ If yes, type -_._---.---_--_------_-- (Plot plan, showing-size of lot, location of system in relat_ion to wells, buildings, etc. must be placed on reverse side,) t'�► q NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK:[ ] Size-----------------------�----------------------- Liquid Depth -------------------------- d Capacity -------------------- Type -------- .'--- Material------ -------------- No. Compartments �►' Distance to nearest: Well ----------------`;`—=- ------ -------Foundation ---------------------- Prop. Line .--_------------------ LEACHING LINE { ) No. of ine's"-------------- ------- Length of each line...... -------------------- Total Length ----------------------------- 'D' ----______._'D' Box ------------ Type Filter Material -----__--_ ---__--,Depth Filter Material ----------------------------------- --------- + Distance to nearest: Well ----s------------------ FoundatIF ' ion___.___.____..-._______ Property Line ________________._._____ ! #Z t SEEPAGE PIT [}] Depth # ____ Diameter _�--_-__ Number ____________________________ Rock Filled Yes ❑ No ,0 Water Table Depth ------------------------------------------------Rock Size -------------------------------- wf % Distance to nearest: Well. -------------------------------------•.-Foundation -------------------- Prop. Line ---------------------- REPAIR/ADDITION,,(prev. ---------------------REPAIR/ADDITION,(Prev. Sanitation Permit# ____________________________________________ Date __________________________________) , Septic Tank (Specify Requirements) ---------------------------=------------------------ -----------------------------------------------.•---------------------------- Disposal Fiel (Specify Requirements) -------'7-- ---SZ------n'14----_--- '----- ----------- C-- .3 -d -- `-1t-X17- .---:------ ------ ----------------------------------------------- ----------------------------------------- ------------------------------------------- ---------------------_--_- -----------------------i: ----------------------------------- ------ - -------------------------- ---------------------------------------------- ---------------------------------------------- ---------------------------------------------- (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, Sete 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 �`` or ----- __ �� --------- title L�-j �t� (If otg an owner), # ' . t�....� FOR DEPARTMENT USE ONLY a! ": APPLICATION ACCEPTED BY --- 'F` ' `------------------ ----------- ---------------- -DATE ,� 3^ 7.70------- .. �.-- ------ BUILDING PERMIT ISSUED------ # DATE ADDITIONAL COMMENTS - ! '�-P ------------ """' , " -�- ��- ---- - o._ef 5�=�L�=?a - ----------- r.. --------------------------------- '`. --- ------ --- ----- -�__ ----------------- - -- --------------------- ti �� o Final Inspection by f Date . Y " SAN OAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'66 Rev. 5M