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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT --------------------------------------------------------- Permit No. 710— -63 �+ (Complete in Triplicate) v -----------------------------------------_..----..---.- This Permit Expires 1 Year From Date Issued Date Issued .�t.r..�.....'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! r ... r c'_.- --- CENSUS TRACT -:'....... ......__.. Owner's Narne A ---� -------------------------------------------------------- ...Phone ----------------------- ----- __._ ------ '= - - --- City -- _. Address . Contractor's Name - tr.a !t 1_'-- . . C1f_ r%. 1 .---7 f r - ..t,.cT.License # -.-- -.---.-. ' a !1 Installation will serve: Residence�}Apartment House Commercial ❑Trailer Court � �O 1 v Motel ❑Other ---------------------------------------- Number of living units:.__.-__- Number of bedrooms --!--Garbage Grinder ------ Lot Size ..2'-v.------------ --Water Supply: Public System and name ---------------------.._.---.....--------...-----...----.---------------------------------------Private 1-1 Character of soil to a depth of 3 feet: Sand P Silt❑ ClayjQ Peat❑ Sandy Loam ❑ 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.) V NEW INSTALLATION: (No septic tank or seepage pit permitted if 'public sewer is available within 200 feet,) PACKAGE TREATMENT [] - SEPTIC TANK[ ] Size-------................._--- ---- ------ Liquid Depth ........--.--.---- ---- Capacity --- -------------`- Type ------------------- Material---------------------- No. Compartments ................. ...- Distance to nearest: Well ------------------------------------Foundation --------- ------------ Prop. Line ............... LEACHING LINE [ ] No. of Lines -------------=--------- Length of each line------.------------------_. Total Length -------- ------ 'D' Box -------.---- Type Filter Material ........... ...... .Depth Filter Material ----_.--- - ------------------.-...-.. .Piotnnrn fn- re<t. Wall�-- _U..fa f�4 Property Line SEEPAGE PIT [ ] Depthh - ------- Diameter:.-. ..- .. Number Rock Filled Yes ❑ No ❑ Water Table Depth --------------------------------- .....Rock Size --- _.--I-. --.--- - Distance to nearest: Well - _... .-._Foundation ------ Pr D. Line - .._....... REPAIR/ADDITION(Prev. Sanitation Permit# - - -- - .. ... - Date .„t------ ---Septic Tank (Specify Requirements) ------------------------------------------------ ----- .............- ------- Disposal -- - -- -- - Disposal Field (Specify Requirements) ------_.._.----------------- -----k ` --=--------`--------- -- ---- t ------- --- ---------------- -------------- --- ------------------ -' ------- - ---- --- - --- (Draw existing and required addition on re rse side) 1 hereby cei'llfy that 1 have prepared this application and that the be done in accordan yaith San Joaquin County Ordinances, State Laws, and Rules and Regulations of the S Joaquin Local Health District. I lame owner or licen- sed agents signature certifies the following: 1 '9 certify that in the performance of the work for w ich this permit is ssved,}I'shall not employ any p rson in such manner as to become subject to Workman's'Cornpensdtioh I s of California.” Signed --------- ----------------- --------------------- -----------------------------------—------.- Owner B If Cher than owner] I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY d C-r ---------------------------------------- ---------------. DATE 4 --- -'1-v---- - --- ------ ----DATE ----------- ----- --------------------- BUILDING PERMIT ISSUED - - - - - - - - ADDITIONAL COMMENTS 1r--_---------- ------ --- ------- - - - - - ---- ------------ �`` - '-- ------- ------- ----- ---------------------- FinalInspection by; . . .,:� _rr-�-cs�:.!` ---- ---- ------ -----. - -.Date � - --- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M