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rVK OFFICE USE: e. ...................................... ... APPLICATION FOR SANITATION PERMIT ••-- !;Complete in Triplicate) Permit No. .. f ...... This Perr»it Expires I Year from 00#0 Issue Doti Date Issued Application is hereby made to the San Joaquin Local Health District for a described. This application is mode in compliance with County Ordinance No . 549ermitoand existing construulesandtalnd Regul the tionsf8in ' JOB ADDRESS/LOCATION ... 1 ...............CENSUS TRACT ......... Owner's Nam � ................. 012.x -------•--- Address .. I41Yl�T.._ ...---...... n .s P --------�.---------•----- ., city .. �1i7 G..•9, e . Contractor's Name r ................................ ' .. License tlt Ihstallation will serve: Residence❑Apartment House] Commercial ❑Traller Court o Motel ❑Other...._--- ` Number of living units:..-'/,------ Number of bedrooms ... ...G bilge cinder :.....::-••- Lot Size -..... .-,. i Water Supply, blit System.and name ••- s Pu y -----------•............................ . .....Private f Character of soil to a depth of,3 feet: Sand t n Silt❑ Clay ❑ Peat❑ Sandy Loam fl Clay Loam, ' Hardpan I] Adobe 0 Fill Material ............ If yes, type t (Plot plan, showing size of lot, location of system In relation to wells, buildings, etc. must be placed' on reverse side.) I NEW INSTALLATION. (No septic tank or seepage pit permitted if public sewer Is available within 200 feet,) 1 PACKAGE TREATMENT f 1 . SEPTIC TAMC ' l ,. Size__ Capacity � ''1'- -.....==•.................... LiquidDepth ......................... •----------___-:_,Type --- _.... Materiatl.. ...--- -----•----- ..`_ No. Compartments. tistance.to nearest: Well t •-Foundation • -•-------••-•- ..... Prop .Line.,. LEACH LINE { = No. of Lines _.__-------- - Length of each line._ _ Total Length .......... ... 'D' Box Type Filter Material,.............. :Depth=filter 'Material_............. '. Distance to nearest: Well ........................ Foundation ..............._1 property Line } SEEPAGE PIT Nur�ibei . . _ _ { 1 Depth __.._:.---------•_-- Diarneter� : . Rock Filled. es Y ❑ No Water Table Depth ..._ ---._Rock Size........... Distance to nearest: Well y r ................ Foundation _.......... Prop.frail. !ne REPAIR/ADDITION(Prev. Sanitation Permit ' =- --------•.. - =- = Date---....._ Septic Tank(Specify Requirements). ._.:............ .....r -------•-----------!_...°---- Disposal Field (Specify Requirements) _-- -- ,rQ�/ ",� f_. . . e a. _S./:- ------------- rr 1 ' x �-•----.._...._.__................•• •----- - r -...- - � - - ---- ..__..ted .............................:..........•....._....__...- (Draw existing and required addition on reverse side] I hereby certify that I have prepared this application on'd'ihat,the work will be' done in aaordance with San Joaquln County Ordinances, State laws, and Rules and Regulations of the Sari�Jvaquin .Local Health:Disiritij Home owner or licen- sed agents signature certifies the following: .� µ..._ . "I certify that in the performance of the work far'which this ermit is Issued ..I shall-riot em to an'r' a$ to become subject to or main' Compensation laws of California." p y y Person in such man Signed ---- j� f wner i By- -t-. _...._.... .._� . .....T _ � -x ---••--•---.._ _ ( -other.than owner) Title FOR",DEPARTMENT USE ONLY ,. APPLICATION ACCEPTED-BY - - ••------• DATE"BUILDING' PERMIT ISSUED ----- ---- - ---------•------•--------•------•-•----••- -----...._..----------_----..._-.-----------DATE ....._....-- 7 : ADDITIONAL COMMENTS ----•--••-•---•- -•- . .. ..............:...:. ----•-----------------------•----------•----- -- ---•----•............... ------ - •-•-- ! - -•-- ---------------......................• ..............................- ._......--• ------ Final Inspection by: -------------- ....... ... . - ,• EH 13 2a -68 .....................................-•-•---..._._..------------._ ��. �. 4 Date .... ............... . ....... .. f SAN JOAQUIN LOCAL HEALTH DISTRICT . - $/74 3M �