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FOR OFFICE USE: # ... APPLICATION FOR SANITATION PERMIT 7 3 -/0 17 ..................................................... Permit No. ,...._........ -- ;Complete in Triplicate) -•�•••- .......... ............................................ .............................................. This Permit Expires I Year From Date Issued Date issued ....... .. Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: x JOB ADDRESS/LOCATI N .....1_ _Z_ ....1" .._C.4.1�, .Sr�Cl. ................... ...._CENSUS TRACT .C.L:� lCe7-7� .........--- ------ .._... f.._�. t ... TOwner's Name ._... . ..A C.... Phone ... ;1 :7 �__..... .... City _.... r �.........:..........:... Address -� ._C�.._. F11.�L.. :- -----------•--.........•......- Coritractor's-Name 4[1_. _e_. .....License # ..... Phone ° Installation will serve: Residence partment Howe'❑ Commercial ❑Traller Court C] Motel ❑Other _..:....................................... Number of living units:_..._...... Number of bedrooms ............Garbage Grinder ............ Lot Size .. !' rl ............... Water Supply: Public System on`d name ....................... ............... -•--...-...................... ---------------...............Private Character of soil to a depth of 3 feef: Sand'] Silt C] Clay ❑~ Peat E) Sandy Loam C] Clay Loom •-- Hardpan Q'�',4dob [] 'Fill Maternal .. : If esottype _-•- .r (Plot plan, showing size of lot, location of,: system in reiation to wells, buildings,_ etc. must be placed on reverse side.) I NEW INSTALLATION: (No septic tank or seepage pit permitte8 if public sewer is available within 200 feet,) r PACKAGE TREATMENT ] SEPTICTANK j Size................................................ Liquid Depth .......................... I - .. w,.. — * 4 Capacity ........ Type Moteiiai...........:.......... No. Compartments ....................... y� Foundation ......._._. Pro Line .Distance to nearest: Well .......:.`~:...:: --- - ..r :�-. :.. . p. ................... J 11 LEACHING LINE [ ] No. of Lines -------------------- --- Length of anal'line--__-- . v_____....:__ Total Length ---------•------------•.- r � - y 'D' Box ...:...---.. Type Filter Material.------------------ Depth Filter_ Material .. .....................................:... ..� / Distance to nearest: Well ................. ........ Foundation ...._... ............... Property Line ._..._..--••---....... . SEEPAGE PIT „ De th Diameter ; Rock Filled? Yes No I1 p r �' -----=---------- Numbs -----.....----._,::........ ❑ G Water Table Depth .....................Rock Size Distance to nearest: Well ..:.....................................Foundation .................... Prop. Line ......................0, 7 REPAIR/ADDITION(Prev. Sanitation Permit*# . Date ....'..........:........:.:...:y . Septic Tank (Specify Requirements) .._... ------------ •-----. ............ .......4r..........w--- _.......... ......... ------------------- Disposal Field (Specify Requirements)� ?P &-...dx:+�_.,,� s�e t__. ......., .-•---- --- --�1.._.... f_. ............... i.�__�<.1°------D�,�.p-------1.�.C'�.t.,�---, _�_.......��t��-r__�---•-----�----.-.��.._e................................... (Draw existing and requi�1.4red addition on reverse side) I 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. dome own*r or licen- sed agents signature certifies the following: "I certify that in the -erformance of the work for which is permit is issued, I shall not employ any person in such manner as to become su to or n's C pens�iti i of California." Signed ........ ---- --- --- - --- Owner By ................................................................................ ........ Title .------------------.................................................. ._.. (If other than ownerl TMENT USE ONLY APPLICATION ACCEPTED BY ..... ....... ............ .................................... DATE ..11= :: .. .......... BUILDING PERMIT ISSUED ...... ..... . ....... . -. ..... ...............................:..............DATE ......... .................................. ADDITIONAL COMMENTS ---- ------- ---- •-- ------• •---•-------•--------------...........-••---•----.._..--------- ..........,:.._•-----•-----.......:.._. Final Inspection by: .. a - Date . �j== G�•`jT . ... . . .... .. . .. ``. : r NGiUIN LOCAL' WEALTH DISTRICT E. H.Z3 24 i-'68 5M 7/72 3 LK