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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT .6 /I ; �--�- Permit No: �-------- �-----•---- ------ - ------- (" --- [Complete in Triplicate) Date Issued ----- ----- -------------" --- This Permit Expires 1 Year From Date Issued rmit to construct and e work Application is hereby made to the San Joaquin Lacal with CO Dt�stOrd nan a rict for a No. 5A9 and existing Rules tand hRegulations: I described. This application is made in compliance w Y � ✓�/ley . McL 1S /1 7� as --CENSUS TRACT ------------- JOB ADDRESS/LOCATION ' Phone ---------------------------- Owner's Name Z"e,.e,V7V— City --/1rfE'.S _ -• Address ----... BFB "-44.4. ----- -- -- (' License #,,p Phone 4 Contractor's Name _��rL'-�icl---✓'��-� ��''" --�-�""" "--------- Installation will serve: Residence F1 Apartment Hous Motel Commercial; railei Court ;❑ Motel ❑Other ------------------------------------------ Number of living units-------------- Number of bedrooms ------------Garbage Grinder ----------.- Lot Size --5 ----------------------------- ----------------------------- --------------Private Water Supply: Public System an name ------------------------------------- - Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ y e ---------------------------- Hardpan ❑ Adobe� Fill Material _____.___"._ I es,type I (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverIsidel ' NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,)SEPTICTANK; Size lQ Q Z'---------------------- Liquid DepthPACKAGE TREATMENT [ ClCa acit �d TypeMaterial"_�OE ��No. Compartments __:p Y ------ fi Foundation _-- _4'0--______ Pro Line ..�Distance to nearest: Well __-_--15V --- pQ ------------ LEACHING LINE [ ] No. of Lines ------- _---------------- Length of each link_- - ©---------- --.--- Total Length ------ ----- 'D' Box Type Filter Material _V_ 7_ _�---•Depth Filter Material ----/dF------- ------------------ - i ---------- Property Line - -----------�I Distance to nearest: Well -1-6 ------��-- Foundation 1"" p tY 1 Diamete f 3fo-_"---- Number --------j--------�---- Rock ck Filled Yes 9 Ifo 0,, SEEPAGE PIT [ ] Depth _ Water Table Depth "-_ E ------ ------------ Rock Size I \ Distance to nearest: Well _I..5`�-------------------- -------Foundation __10-�------- Prop. Line �. ------------------------------------------ REPAIR/ADDITION(Prev. Sanitation Permit# Date ----------------------------------J Septic Tank (Specify Requirements) _--".---------------- ----------------------------- Disposal Field (Specify Requirements) ---------•---- = --------------------------------- ------ ----------------------------------------------- ------------- ----------------------------------------------------------------------------------------- ------------- "--""- {Draw existing and required addition on reverse si d e) - . 1 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: "1 certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to become ject to orkman's Compensation laws of California." Signed ---- -- Ct Owner Title -------------------- (If other than o er) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY tiv = �--- --------------- --------------- DATE �Cl- y ,�- -------- / � r --- -------�-- -------DATE -------- -------- ------- --------- --- BUILDING PERMIT ISSUED ___________________________ ADIT N L COMMS S, _ ----- - - ------------------------------------------------------------------------ t 1 � � J -- - . ---------------------------------- ------------- --------------------------------------------------------------- ---------- :�- ----- -- ------�- ---------------------------------- _. ---------- } / / ------- ----- Final -------- --�------ - ___________ .Dae -- - -- Final lns action b ------------------------ 5 " ----""- /� 5 JOAQUIN LOCAL HEALTH DISTRICT i E. H. 9 1'-'68 Rev. 5M s