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FOR OFFICE USE: APPLICATION FOR FOR SANITATION PERMIT ----- (Complete i ` -- -- -- -'--�`--- --- n.Triplicate} Permit No. __-- - ---------------- -____-- . : ------------------- This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Jo quin Local Health,District for a C� 3 - �` � D described. This application -made in,co lienee wit Co ` t Ord' permit to construct and install he work herein X fiance No. 549 and existing Rules and Regulations; n [�O JOB ADDRESS/LOCATION tr!ts/a.�- 'f10� -� � '_ NSU TRACT Owner's Name � ---� f - - -------- r Address -------------------- - :------ one T -- _ City Contractor's Name _.- --- ----- ----- --•-- ---._.License# --=-- �-- ----------- Phone V_=fii9e'4T Installation will serve: Residence Q Apartment HouseQ Commercial*railer Court Q Motel Q Other Number of living units_____________ Number of bedrooms __._____ -- Garb ge Grinder _ ----- --- Lot Size -----_,-__-- Watar Supply; Public System and name p ----•--.-- -------- K.V_ Character of.soil to a depth of 3 feet: Sand' Q Silt Q Clay - Private Q --• Y Q Peat Q Sandy Loam Q Clay Laam:Q Hardpan Q Adobe XFill Materia!l. ---- ------ If yes, type -------- ------------------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse NEW INSTALLATION: -)f . side.)r (No septic tank or-seepage Jplt,,permitted if publ'clsewer is available within 200 feet,) PACKAGE TREATMENT { ] SEPTIC TANK + ' j Capacity _ t ------ ------------------ Liquid Depth J.-- - Type - - -- •--------.----- --- -`-.--- Materia[___-�No. Compartments ' Distance to nearest: Well ---_ _ --- -- ---------------------i Prop. Lme 4De t. p LEACHING LINE - " - Foundation ---/O------------ ------------- -___- - ' [ ] No, of Lines # .0 �`----------- Length of ea line-----_YD__ .. -Box--.� � € ------------ o al ngthv�---�'Q �.--------� Type Filter=Material!- ^' T t L --•> L Depth,Filter Mater.iai._ f� V_/:_� - ------ � r�, --to. nearest--Well �: - n' #' • , :, ` Foundation rsr-_�_: .» :t..� _. SEEPAGE PIT l : 'Jr1 t �� -rte i - - Pr610erty� Line=2-- -_-• ( ] Depth ---- --Diameter ' --„_=---_ Number•_-.- ..�,---------- --- i •` `` Rock Fillecl Yes' No . Water Table Depth ---------------------t � c - fr >, p ----'-��,_-_�--•- ------Rock Size :. Distance t0 nearest, Wel! _____________ �-�%'P i a i1 I P - - -----------Foundation _ .__-- Pro ine'[l -! i RfPAIRJADD}TION(Prev. Sanitation Permit# x.___ p�, t �" Date '1` _- Septic Tank (Specify Re uirements ; } ------- - Disposal Field (Specify Requirements) ------------- --------------------- __ _ -------------- ---------------- ------------------------------------------------------ ----------- - -- -------------- _ � (Draw existing and required addition on reverse side) � ---------------------------------- (Draw -�--- ---"-- ----�------ I hereby certify that ! have prepared this application and that the work will lie>done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaq n Locdl Health District. Home owner or lieen- sed agents signature certifies the following: i "I certify that in the performance of the work for which this permit is.issued I shall not em Io an i as to become subject to Workman's Compensation laws of California." ploy y person in "h manner Signed 1 -------- -- - ------ ----- ------------- ------ ------ Owner BY --- ---- - - l ------------ Title -------- 1 (If other t owner) - ------------------------ FOR DEPA"T - T E 1,Y COMMENTS--,ING RIISSUED ._ _-j _{ i ' i r pp AC PTED BY_____--____-_ -- - x- �1 - , DATES F ._/L---- -------------- ADDITIONAL ,.: ---- --".-"'--BATE ------ ------------------ -------------------------------------------- ,, -.� --- --^' �.- - ----- ------------------------------------------------------------------------------------------------------- ------------------------------ ---- -- - -------- Final fns action b � -- ----- ---- ------ - -- � ---- ------------------- ------ ----------------------- ----- ----- ----- -------- `---Date - --"(P --- AN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 �,_l-'68 Rev. 5M.