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r FOR OFFICE USE,. _ APPLICATION FOR SANITATION PERMIT :....._. : _....:..-_ IComplete in Triplicate) ..._._.. Permit No. ._7(Lf�.-� .............. . ............' . This Permit Expires t Year From.Date Issued Date Issued .,7:.� _ �C s Appt+cation Is hereby made to the San Joaquin local Health DistrictAfor a hermit to.construct and Install the work herein f described.,This application is made incompliance with�County;Ordinance No. 549 and,existing Rules and Regulations: t --JOB ADDRESS/LOCATION ....?"�:s.`. ........l' ��Ffi.�la.1 .,,d �,�` � ,k, «. ._._ :. . . ACENS S TRACT Owner's Name,_.. .... ........ Address �. ,....:.. ............Phone ........ .........--•--• -•--- ---- `_. Contrac'tor's Name .. .. �------`--- ...................License � !173 __. Phone Installation will serve: Residence 0 Apartment Housefl Commercial oTraller Court r i Motel Other - � ......_<...._ > , 3 Number of living uni#s:. ::_:::_ Nurriber of'bedroorns ............Garbage Grinder ........ Lot Size Water.Supply: Public System and name-..:=--•--:-•-- - ---- '----•••---------•------------------- ....... ...:: t ....Private � - Character of soil tea depth-of 3-feet::- Sand- [{ y [] Peat Q Sandy Loom ] Clay loam ❑ F _ , ,Silt -r -- -Cls .Hardpan[ , Adobe O Fill Material .....If yes;type............:.. .:.......... .� (Plot Plan,",showing size of lot, location of system,in relation to wells; b Ildirigs, etc. must be placed an reverse sldej NEW INSTALLATION: (No septic tank or seeps a pit permitted if p blit sewer is available within 200 feet,l i PACKAGE TREATMENT h T SEPTIC PANIC Size_;& X's 4 [ 3i l -_.---•• quid Dept r�: Copacity -4,T Ype: •, sc� o Materlal. _<. No, Compartments ......! C ' Distance to nearest: Well nd F . k:.�. ..Fou tion __ Prop. Line a .1 t�. LEACHING LINE [1�' No. of Lines ------- ------....... Len th of each fine.._-+._ d/ _.. 9 - --. Total Length" V.Box .._.�.._... Type Filter Material . ..... Filter AAaterial-.../.�.._".. V: a .._...--_..• - -- - __,mss„-,•�,�� _ _ ,. .. �. Distance #o nearest: Well Foundation 1-d..14---: _ �- -- . . . P op�ey- l ine NU PIT tept � m,er......._..f-__.... ---.. Rock FilladY e s - S � o Water Table .De th, -•-�.b � ........Rck Size._ .... o �� . ... -••y ' Distance to nearest: Well.......... - }. .. .. Foundation . q � #P rop. L n e . ...l4iPAIRADD1T10N{Prey. Sanitation Permit i Septic.Tank (Speafy(SpecRe uirements I . . • `Disposal Field (Specify Requirenientsi. ..:..___. I I - .. t . i .-.---•- { ----_-----•-- {Draw existing and required•additfon'on r®verse side) ! hereby certify that I have.prepared this.application and that the'work will be done'in accordance with San Joaquin £aunty Ordinances; State Laws; and Rules acrd Regulations of the San Joaquin Local Health;District. Horne owiner'er licen- sed agents signature certifies the following. "! certify that in the pedormance of the work.for which this peniRit is issued,.I shall not employ any parson in such manner as to become subject to Workman's Compensation laws of California." Signed ._ .... ---- ' ---------------- --' Owner Y �J (if other than 6 wnerl title - ---.. i f � L E R DEPARTMENT USE. ONLY APPLICATION ACCEPTED BY ' BUILDING PERMIT ISSUED ------••---------_-: -------= ---,••.-.:--- - -�_-__�_ DATE-3., .,_I-0 _2_ADDITIONAL COMMENTS ---.----•--- -------•---•----- -.-._ E ...................:.. ..... ' -----------• .................................... --------.---------- -------------------------------------------------- ........................ _...-. _ Final Inspection by: _. ------- Date - ..._...--------_--------- Eli 13 2b 1=68 V. 5M --------------••••�- ----•-------•--•- -------------••-- -- SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M