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FOR OFFICE USE: 7 1 APPLICATION FOR .SANITATION PERMIT Permit No. l_1 -- - / �1 ��-3 a----"" (Complete in Triplicate) ----------- Date Issued -------------------------------------- ..La_"_c -• This Permit Expires 1 Year From Date Issued 4-; e work rein Application is hereby made to the San Joaquin blithe Counalth ty District for No. 549 and existing Rules ermit to construct and tand hRegulat ons.. described. This application is made to p CENSUS TRACT JOB ADDRESS/LOCATION _--- `""" Phone -------------- Owner's Name ------------- 1✓'� i�_L I_ ------ ------- city!c ----- - - a -�'-------- Cit ------- --------------- - Address ------ ----- -- I Contractor's Name - -c�_- ------ -- - ----------------------------------- A ------------- --- LicenseJ+.SF Phone Installation will serve: Residence�rApartment House❑ Commercial ❑Trailer Court i❑ F Motel [j Other ---------` _y ------ --------- •yGarba a Grinders p"----- Lot Size --------- Number of living units:-._-_.)___ NumberN-1-A bedrooms_ Q �- •�; g Private ❑ Public System and name - Water Supply: Y - " Silt Cla Peat E] Sandy Loam [] Cla Loan? [ICharacter of soil to a depth of 3 feet: Sand'❑ ❑ Y ❑ -"Hardpan ❑y Adobe' FilllVlaier�allr� Q -yes,type etc. must be laced on reverse side.) l (Plot plan, showing size of lot, location of system in relation to wells, buildings, P NEW INSTALLATION: (No septic tank or 5eq.p�age pili permitted if public sewergrs vailable within 200 feet,) SEPTCTANK:[ ]I Size--- Liquid Depth -------------- =------------------ PACKAGE TREATMENT ( ] ---- -_-----•-_-.---- O► 7 e-------------------------------- ic ----------=--=- No. CompartmentsCS Capacity�� Yp Mater - --- Prop. Line ---------------------- . .___Foundation_----------- ---- i t " Distance to nearest. Well ' 4.No. of Lines ne-------------=------- ------ Total Length ----------- -------•- LEACHING LINE [ ]• Length of each line D' Box .----------- Type Filter Material ----------------'----Depth Filter Material r' Foundation t-�f-------------- Property Line -------------------r--- Distance to nearest: Well ________.__"_.__----- Diameter ---------------- N=4- --------------=------------- .Rock Filled Yes ❑ No SEEPAGE PIT [ ] Depth -------------- i ` ,t I a ' Water Table De th Rock Suer-."" ---Foundation )�...�---- !`� �'Prop. eine y Distance to nearest: Well _.______------------------------ . 11 1 ' ------' Date '" ' '-------- - -----) REPAIR/ADDITION(Prev. Sanitation Permit ----- - Septic Tank (Specify Requirements} --------------------------------- - � � ------- ---------------- -------- Disposal Field (Specify Requirements} ____ 14c— _. ----------- = -------------------- ---------------------------- ----------- -------------- ---------------------------- - � (Draw existing and required addition on reverse side) rk will be done i 1 hereby certify that I have prepared this.,-application,and that„the wonraccordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the. San Joaquin LFiealth Lo 'District. Home owner or licen- sed agents signature certifies the following: person in such manner 1 certify that in the_performance of the work for which this permit is Issued. f shall not employ any as to become subject..ao Workman's Compensation laws of California." it caner _ �' ----- - ------------------------- O Signed -- -- --- ------ --- - ------ ,i (if other than can" - POR DI"PAitTMEN7 US ONLY DATE d . � APPLICATION ACCEPTED BY _--__ _.__- -- ---- _ DATE ` BUILDING PERMIT ISSUED --------"------------------ - - ---- ADDITIONAL COMMENTS ------------------------------------------------------------ �t �---- - --.r-- - -- 71 ---- - ----------------- ----- --------- - ------ Da Final Inspection by: --=--- -------- - ---- ----- SANQUIN LOC L HEALTH DISTRICT F N 0 1-'68 Rev. 5M, :,