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FOR OFFICE USE `` ' PLICATION FOR SANITATION PERMIT Permit No. ----------------------- (Complete in Triplicate) ' � Date issued---- ¢sem This Permit Expires 1 Year From Date Issued -- F ------------- ------ Application is hereby made tc the San Joaquin Local Health District,for a permit to construct and install the work herein e,4—T,h I,i � dpi ` compliance with County Ordinance No. 5 and existing Rules and Regulations: i 0 S CArn6� `� • � F F 15S `! - . --- ------ -CENSUS TRACT ----: --------- -- -- Owner's Name _.__PH f4 -1 �!1V_ed-�1- _.__ Phonej . fax 3t '�- �I city LPTH_ --- --------------------- ---- Address ---- ------ - --------------------------- i Contractor's Name - ' V'--------License # __ .- ��-- --- Phone .. tx Installation will serve: -Residence "artment House-F] Commercial :❑Trailer Court ;❑ Motel ❑Other -------------------- ----------------------- r 1 - , ` I 3----_Garba Gri +r�(�_.__ Lot Size Number of living units:-----(------ Number of bedrooms .. ge , nder M. Y� Water Supply:•Public System and name --_ Private El 1 Character of soil to a depth of 3 feet Sand E] Silt F1' Clay .❑ Peat El Sandy Loam Clay Laam ❑ 1 � Ha"r p my❑�` -Adobe ❑ Fill Material ._'it yes,.�ype,"' F !1 (Plot plan, showirig..size of jot_l.ocation,.of system in. relation to wells,,buildings, etc. must be-placed on reverse.fside.) i NEW INSTALLATION: (No septic tank or seepage pit permitted.if blit sewer is available within 20d feet,) 1�.; �i SEPTIC TANK;pr' Size_ Liquid Depth ;-= ---" -. PACKAGE TREATMENT [ ] � 1_ __ ___ 1 i Capacity Q Q-.-- Type t V Material-COMM 1�-..-- No. Compartments ' --= Prop. :_-_' - '-------- � E � i 1 '1 Distance to nearest: Well ________ i ______________Foundation _______� p I r �--- Length of each line-..---��-�------ --- Total Length LEACHING LINE No. of Lines ------ -- - I 3 'D' Box a yp F _Materia ��J T ` e Filter Material , � Dep " k - th Iter � i ( i� F �` _/' esP-ropert-y�}Lne 4 t .. ovndatlon ._ _ -Distance-to nearest:-Well a ----- - ' ��k•l ` ---------------- Yes�❑ Na_____ Rock Filled SEEPAGE PIT pDiameter --------------- Number; id ) Water To Depth "`' ----_-'-'---------Rock Size-------------------- ----••------ 1 -- '= F : '3 �.- -'Foundation --------------- Prop. Line ------------ Distance to nearest: Well _ _ ` f REPAIR/ADDI,ITION(Prev. Sanitation Permit# ----------- -----�----------------------- Date ----- ---------------- } � ..��. . �_� . T- T .«-J....-�.....F._-.._ _',--.. w....-"`-.--•----- --------�r.t--------- -------------------- Septic Tank (Specify Requirements) -------------_--- - - - Disposal Field (Specify Requirements) --- �- f - = -- ---- __ ____ ------------------------- ------------------ . ' - ------------------ ------------------- (Draw ---- - ---(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 liven- 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 anyiperson in such manner as to become subject to Workman Aompensation'laws of California." _ s ------------- Owner 1' Signed �J;- _ — i Title --- ] ---- --------- --- --------- ------ BY =----- ---- 3 (If other than owner) I i FOR DEPARTMENT USE ONLY ' I ------- -- 3 �- DATE --'----- ---- - ---- - --'�-------- APPLICATION ACCEPTED BY ____ � R` 0-- -- _ ---_ BUILDING` PERMIT 155UED'_._ --- _ _ ADDITIONAL COMMENTS -_ - -Z � { ---- - - _. _- - ___�.�_..___.-Z' - - --- - - ----- ----- -------------- �""� -�"-""'--"'""- ----- �---- ---- -- . - - -- ---------------------------------------------- - ---------- -- -------------� --- ----- / / Final ins b -----Date -- - [ SAN,.JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M ,.,�