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ILI FOR OFEIEUSE: APPLICATION FOR SANITATION. PERMIT_,,,_, A' y _. - N �p- 4 Permit o. -- --------- S {Complete in Triplicate) ------------------------- -----^ I-s.-':------ - Date Issued -------------r---- --- --------- This Permit Expires 1 Year From Date Issued f . 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 Count�Or mance No. 9 and a ist' Rule and ulations:` A rCEN TRACTS a JOB ADDRES5%LOC ION - - -�r- .�- Ph Owner's Name ( _ -- --- on - X Phe �y a -� v� IF Address - "f City _ Contractor's Name _ _ _ . -- . _,__ �[r -- -'_ Licensey% __ P�tone _ 2 `x-4 Installation will serve: Residence artment House-E) Commercial :❑Trailer Court '❑ Motel ❑ Other --- --------- -- , Number of living units:___ -'—"Number of,bedfaoms �: Garba a Gririder�" Lot"Sz"' ��- _ Water Supply: Public-System and name __________________ ) �____Private f ---- - -------- ------------------------------ Character of soil to a depth of 3 feet: . Sand'❑ Silt❑ ., Glay 0,. .,Peat.❑ Sandy Loam '❑ !Clay,Loam;x I Hardpan ❑ Adobe ❑ Fill Material.----.des, type ..:-- (Piot plan, showing size of lot, location of system ins relation to- wells, buildings, .etc, must-bye. placed on reverse side.) NEW INSTALLATION: (No septic tank.or seepage pit permitted if public sewer is available within 200 feet,) X, 1 PACKAGE TREATMENT SEPTIC TANK'[ I' ! Size____C�-/<_ ____ .____ .____- Liquid Depth _______________i__ v I t Capacity _/,a2�Gg_-- Type _ Materia!_ Nod Compartments oGr-�____ } f - -=--- ` IDistance to nearest: Welt ____ �- __-________--__Foundation_ _� - ) Prop. Line _ _______________!:__ G\ LEACHING LINE lle 'No, of Lines o -- ---- /.____ Len of e4ch , e_ ngth _.:P f�__....____oo� e-_ Total LeD' Box ._____._.--- Type Filter MateriaDepth Filter Material " ?_-___._ Distance to nearest: Well -- ._ �, °f----- Foundation ��--- -----_.__ Property ,Line -------------•-_;__ s � i SEEPAGE PIT �' D'epthi -":+�--/-/0-_(?Diameter -- ._ Number -- QZ7-------------- Rock Filled `fes No 0 Water Table Depth.- f- e----------------------------------Rock Size�-.-- ----------- Prop.- _ i ! , , DFstance to nearest. Wel! __,� _--______________':-_._...Foundation Line ____�___.__ REPAIR/Ab $ ----- -------------------------------------- ! DITI IN{Prev:;Sanitation Permit# -------------------------------------------- Date ----------------------------- -) s F' �- F . � fSeptic Tank (Specify Re uirements ------------ -------- - --- -- -- =-=---,a -------------------------------------°--- Disposal Field (Specify Requirements) ------------------------------------------ '`----------------------------------= f-------- { - fi x --------------- t ,. . (Draw existing and required addition on reverse.side) _ �j 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;Reguhations of the,San.Joaquin Local Flealth,,District. Home owner or licere= sed agents signature certifies the following: iLA "I certify that in.the performance/of the work for which this permit]iso ssved, 1 shall not employ any person in such manner as to become subject to Workmcgn's Compensati.onlaws of"California." _ aF f Signe - ------- ------- --.--------• e � f' ` B k 4 '7itw` {Ifo er t n owner] - .r.'��.•. .�.,,-�..-•� --�_... y t` FOR DEPARTMENT USE ONLY F APPLICATION ACCEPTED ,BY -------------2------------------------------------------------------------------------------------------ DATE - BUILDING PERMIT ISSUED -- ``' == ----------------- -----DATE.------------- ------- ------ -- I(�' -Tti=Ly `- ADDITIONAL COMMENTS -- -._r. �=� f ---- -------- ------------------------------- -` -- ---r--- - -- i ------------- Final Inspection by: t ate AQUIIV LOCAL HEA THIS DISTRI E. H. 9 1-'68 Rev. 514 ` - _i