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FOR OFFICE USE: APPLICATION tOR SANITATION PERMIT ` Permit No: ---�---�� - (Complete in Triplicate) -- ------ � Date Issued S=-�---7-L-: ---------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is made in compliance with ounty Ordinance No. 549 and existing Rules and Regulations: ��.�- f 'C-��GL1..0 ,A -��..li� .. is TRACT -------------- ----------- JOB ADDRESS/LOCA_.T�IO�N ._-- -- �- -- Owner's Name r--R / f� --------- r__ ----- -------------------- - Phone Address -- ----- ---- ---=- -- -�- � - -- ��f. -------. City�.� i------------ - ----------------------------- -----•-_----- G ense #rrPhoneiic - �- . ---- Contractor's Name ms Residence crtmentHouse❑.Commercial ❑Trailer Court ',❑ Installation will serve: Resid ®�� Motel ❑Other -------------------------------------------- / Number of living units:---_. ____ Number of Broom;-_ �_�Garbage GO dere Lot Size _ � -<.- •-�--•----••---• Private ❑ I Water Supply: Public 5yst m and name -- ----- --�•-----z�_ F1 Sandy ------•-•--------------- Character of soil to a depth of 3 feet: , Sand'❑ Silt El Clay CI—Peat Sand Loam ❑ Clay Loam ❑ I Hardpan F] Adobe Material ----FiAAt yes, type ---------------------------- (PI'ot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,)L y , E TREATMENT SEPTIC TANK T_ ' e------ - = (i----- ------------ Liquid Depth _-_!_____------=----.--_- PACKAG [ ] ��_ �.40. Compartments �---=---- Capacity -�'f' t3 - TYPe eVV_XMateria --- / p Distance to nearest: Well ------`7� - ---------------Foundation __/__ _V----------- Prop. Line Wil___...-----•--- - _ f LEACHING LINE [ No. of Lines '- -' -- Length of each line-/4------- -------- Total Length - r �' 'D' Sox _1j,fc�_'"Type FiltertMatenal �_�__-�_-_-_---Depth'-Filter;�Mater�al ___--��----------------=-=---=_-=-•� s Distance to nearest:.Wellr_ —'------ Foundation _- - ------- Property Line __:_.-__ ' SEEPAGE PIT [ Depth _c�- --- -- Diameter __- ..��-- Number -___--_-___-_b J----____ Rock Filled Yesy No i❑ Water Table Depth -------- -Lj� --------------=--------Rock Size --��x---�� -j------- .�-- Distance to nearest: Well ________�r -- ----------------Foundation ---�Q____ Prop. Line _wa-�--------••-- REPAIR/ADDITION{Prev..Sanitation Permit# -------------------------------------------- Date --------------------------------_) Septic Tank (Specify Requirements) ---------------------------- °-------------; ---------------•---------------- ------------ Disposal Field (Spee y`Requirements) ----------.- i .: ___ --------- ---------- - - - - - - ----------------------------------------- ------------------------------------------ --------------------------------- ---------------------- ------- - - (Draw existing and required addition on reverse side) 1 hereby certify that Ihave prepared this application and that the work will be done-in accordance with Son Joaquin County Ordinances,..State Laws, and Mules and Regulations of the San Joaquin Local Health District.-Home owner or licen- sed agents signafure certifies the following: "I certifytitliat;iin the performance of the work for which this permit is issued, I shall not employ any person in such manner J`gas torbecome subject to Workman's Compensation laws of California." r4. f"\ - � gSi ned'' ---`` t----- - - ------------- ------------------------------------------------ caner _ '6 Q'11 Tithe ---( � Pf.:other than owner) FOR DEPARTMENT USE ONLY tr APPLICATION 'ACCEPTED BY ._-- _ -- --- DATE ---M-7-----�--------------- BUILDING'PERMIT ISSUED DATE - ADDITIONALCOMMENTS ----------------------------- ---------------------------------------------------------------- -------------- -------------------- T_ -------------------------------------------------------------- --------------------------- --- ------------------------------ - ---------=---- Final Inspection b Date _ -A -----__- - - .__-- - SAN JOAQUIN LOCAL HEALTH DISTRICT G t E. H. 9 1-'68 Rev. 5M.