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' - FOR OFFICE USE: ' ` APPLICATION FOR SANITATION PERMIT �. - -= ---------'------------------------------------ '' Permit No. --'- '----'---- (Complete in Triplicate) y + Date Issued l/ - -------------_---- --_------------------------ a_n_g -.his Permit Expires 1 Year From Date Issued $asr -res FI�� Application is hereby, made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This appli 7 Sorn ;ante wi Dunt Ordinance No. 549 and existing Rules and Regulations:. C rnt3R1 PG-fir=` .� M'.iUi�Y JOB ADDRESS/LOCA I "_ �- - ----.--- --CENSUS TRACT ---- ----------------- r ' Owner's Name Phone - _ Z2�...� w I Address ©' xQ` --------- City AN- ' Contractor's Name - N1LL _per-- 00X'- ---- (-Q.....---- `_"a License # -_ 0 6 Phone Installation will serve: Residence �rtment House❑ Commercial ]Trailer Court ;❑ i Motel ❑Other -------------- ------•----------------- -- I f I Number of livingunits:._---;r_-__._ Number of bedrooms __� Garbage Grinder N-� Lot Size ----�D ��f� � "�--__-- g > 1 Water Supply: Public System and name ----4ATN-RQ-f.......--C1T.X-----kv._ rt��'R-------CQ----------------Private ;❑ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam lay Loam Hardpan ❑ - Adobe ['] Fiil Material-- L1:--If-yes;-type — ----=-:- _ r (Plottplan,l-showin silocation ,of system in relation to wells, buildings, etc—most be—placed on reverse side.) 1:. W'INSTALLATION: [No septic tank or seepage pit permitted if blit sewer is available within 200 feet,) NE --__._ Liquid Depth ----� PACKAGE TREATMENT { ] SEPTIC TANK Size-__ _-_ - -.----._ q p ' - --- i Capacity Type t'ou _ __ Material-_C Wk— No. Compartments ;---` ...... Distance to nearest: Well a!� __-_-_Foundation _____1� Pro Line`----_ *? P - LEACHING LINE (�'�No. of Lines ---.---_2-_-_--------- Length of each line---.-.--_ -------- Total Length .-----1_'76............. �r 'D BoxlxE5 T C r ' I � � �� - : . - '�_ :�;..� �,-' �,� Filter.�Materiai ------�--+t=�� ' � ----------- Type Filter Material ��- Depth -------------------------- ts f t I [ SEEPAGE PIT�I [ ] Depth .--- Diameter ,,_ Number ��-'-----�_-- � --Property"Lane -__ -._. istci'nce to.nearesfi:..11eli__--� :--_;__;___- Fourkdafiian -_ � � --- ==- ----- -- -- Rock Filled Yes [ No .0 Water Table Depth ---- -`---,["" ",._:--------Rock Size j ?:> iI Distance to nearest: Well -------------------; ---------I------Foundation -------------------- Prop. Line --------------------- REPAIR/ADDITION(Prey. Sanitation Permit# ------_---_------ ----_-- _ _ __..__ - mate ' = ) - e t Septic Tank [Specify Requirements] ____________________ i ------------------------------------______________________r- Disposal Field (Specify Requirements) ---------------------- `- i 3 I e 11 3 i W'1'f1 .3 t° ----- -------------------------- ----------------------- 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, 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 sucK manner as tosbeco_me subject to Wor an' Compensation laws of California." i [ Signe'da7 �'?r '�A ------------------ Owner t BY ---------------------------------------------------------------------- Title " } _ ---------------------- - ?- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --------'-�__i--p- -f` ------------------ /_ - DATE --- 7_4 &51-------------- BUILDING`"PERMIT.. ISSUED ------- 1-' -- - -----------------_._. ...___.-- DATE ------------------------------ ADDITIONAL COMMENTS ------- _ ) s -� .` ----------- - -------- `-_. -- - ----- ------- - -- ------------- --/ - � Date----------- s---------------------- -- Final Inp ------ 3 : ' SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M