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FOR OFFICE USE: 4-----_------ .---------- ------------------ APPLICATION FOR SANITATION F IT ---------- -- ---------------------------------------- - ;{ (Complete in Triplicate) r/ Permit No: .6�' :_w1.4_� - ��--- - --- ---- ----- - X11 ------ This Permit Expires ] Year From Date Issued �l Date Issued -__ �/-( ' Application is hereby made to the San Joaquin Local Health District for a permit to construct F and in ! te. warka�herein described. This application is made in compliance with County,Ordinance No. 549 and existing Rules and Regulations: sta JOB ADDRESS/LOCATION Owner's Name _.._ ---------5177--- --------- -----CENSU TRACT ----------------- !2�_�.----�ff "S� ------------------- ------------ -- _Phone --- -- ---- - Address -- vs'.fA , F � ` ----- -------------------------- Contractor's Name --fk.F.S'_ City -6'7'-V --- 7V -- - --•- --STS _ � t ---------------------------•-----• ------ - License # 1775rY 3--- Phone ----------------- ---------------- -- Installation will serve: Residence - -- - - partment House.Ej Commercial ❑Trailer Court ;❑ i Motel 0 OtherNumber - i r living y J Brooms ---3------Garbage Grinder _4/-4_._ Lot Size . ---X��p _ Water Supply:IPublic Ss-stem and Hamer of be - ---- ------------- n pp Y� Character of soil to a depth of 3 feet: Sand's gilt .Private [ - ❑ Clay ❑ Peat E] Sandy Loam [] ClayLoam Hardpan 0 Adobe � E]Fill Material ------------ If yes, type ------------------ {Plot plan, showing size of lot, location of system in relation to wells, buildings, .etc, must be placed on reverse side �~ i NEW INSTALLATION: ) O {No septic tank or seepage pit permitted if public sewer is available within 200 ST feet,PACKAGE TREATMENT [ ]. SEPTICTANK' USize.- ----------- Liquid Depth .!�_.� -Capacity/ 00 Type ' Material �+ /Y ' � . Distance to nearest: Well � No. Compartments -�_ LEACHING LIN1Q -------Foundation -/ '--- 1 Prop. Line �� -------•--- [ No. of Lines _ - _.---,-------- Length of,each line-_ 7 r 'D Box ' ' ------------- Total Length -.L 3-Q Type Filter Materia! -(fy'D-G!� --- Depth Filter Material _- _y-"� Distance to nearest: Well .....S_a1----- _ Foundation ---f - ------------------- Property Line SEEPAGE PIT. [� Depth -�_�r { .. - -�`--~--r---------•-- -- ----- Diameter _-=�'3------- Number -------_---- - -. '�-------------- Rock Filled Yes EF-- No i❑ Water Table Depth -- 1 ' --------------------------Rock Size 1__,,'-�_' ------ Distance to nearest: Well -----.f�Q-� _ _ '' -------- ._Foundation ...1 ---- Prop. Line -- REPAIR/ADDITION(Prev. Sanitation Permit# _____________________ _ �- - -{ p . __... -------- Date -, Septic Tank S ecif Re urrements) 1 Disposal Field (Specify Requirements) _----__- •------------ •--------------------•---------------------------------- -------------- -------------------------------------------- --- prepared hereby y (Draw a pilin -- -- -- - --_ i ----------•- - -- - - - - CounOrdinances, that I have re ared this a licg and required addition on reverse side) � ---"-� ---�-------------------- Iion and hat e work will be ty State Laws, and Rules and Reg lationstof the San Joaquin LocaloHealth District.ne in dHomerownan Joaquin � P sed agents signature certifies the following: er or licen- "1 certify that in the performance of the work for{which this permit is issued, I shall not employ an ers as to become ubject to Workman' Compensation laws of California." y P on in such manner r Signed - � Owner (If other than owner] Title -. ..". 7 ._..._."-.--_._..- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _ k ADDITIONAL COMMENTS ` �� = - _ ,L= _---------- ----------- - ------ _� DATE ll�. / BUILDING PERMIT ISSUED / DATE --- --------------- - --------------------- ----------------- ----•- -- --------------- ------------ _ CJ -_ Final Inspection b - --- -------------- ---------------------•- - - --------- a g ------ - -- -- ------Dat -. e ----- --- - -- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M a }