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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 7sr-�fLs ............. ........................................... a .,, V Permit No. ------• (Complete in Triplicate) ..................----------------- Date Issued ..7. 3. ........... This Permit-Expires; I Year F;ga_m Date issued Application is hereby-mode to the San Joaquin Local Health Disi ict-fb cs perrnil to tons"truct on��ifitall-the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations t JOB ADDRESS/LOCATION,.--L/CSL.:., ..,.._.. --.. Xr--=--•.--._.I ............CENSUS TRACT .......... ............. . Owner's Name .... ...... ................... ............ ....Phone • 3 /Address -------------------------......................... ...............-/---�------- ........--- ... city ----- ............... Contractor's Name ------....- Licenses=a .�1 -- Phone Installation will serve.. Residence pApartment Houseo Commercial 0'Trailer Court Q iMotel:❑Other --------- --•---_------------ Number of living units:_____-•---.. Number of bedrooms -----._.Garbage Grinder,._....__._ Lot^,Size - -1p��--------------- ,�f { Water Supply: Public System and name C;��/ l666 ----- -'� . ...... Q...........Priv t Q? Character of soil to a depth of 3 feet: Sand Q Silt Q Gay ❑ *egtjb Sandy Loam Cj` Clay Loam El Hardpan ❑ Adobe Qi Fill Material ........- If yes1/type ............... ............ I (Plot plan, showing size of lot, location of system in relation to wells, `buildi�t�gs�\,e4 must be placed ori reverse sld NEW.INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available wittrin-200 feet,) PACKAGE TREATMENT SEPTIC TANK t Size.....��4.V-•----- Liquid Depth -__-------- Compartments ----•-Com artments .............Capocity /.2w........ Type ice . Material Distance to nearest: Well nclation -_-; ' Pro Line . ..... ... :Fou _ i ,�- p• �- i LEACHING LINE [ ] No. of Lines -----------_ _...... Length of leach lin e,----. _ ,t-- Total length ...... ...... 10 'p' Box --- Type.Filter Material _.'P s. ....-Depth .Filter M sal ------ ��..�........................... ....- YP } 1 t .......... .......... Property Distance to nearest: We ....°�-�_..,------..R�jFd�da ion _' Pro er Line ............. .......... SEEPAGE PIT [ j Depth ..... ..... Diameter -�R.......�- mbe ------- •---------- Rock.Alled Yes M . No 0 Water Table Depth ---------•- •---•-_. ock Size ...1_.t�.l'��...... .... Distance to nearest: Well .......:.......t__....................tounclotion ............. Prop. tine ----:---...--.-=------ REPAIR/ADDITION(Prev. Sanitation Permit "� --...--•-----------••-• ....... Dote l)ate ........----------.............--- Septic Tank (Specify Requirements) ............. -•----......... ----- - ------- ............ iDisposal Field (Specify Requirements) •--•----•----•.............1..---.......---- ... ................ ------ -------------------------------------------- ------------ --------- -----:.__..--- :------------ ---------- ----------- -•---------------------...-..----------------------------.- ! •------------ ................... .............. -----------------------------•......------------------------•---•----------- - - ; (Draw existing and regdired addition on reverse side) . t I hereby certify that I have prepared this application andl that the work will be done in accordance with Son Joaquin County Ordinances, State Laws, and Rules and Regulation: of the Son Joaquin Local Health District. Home owner or liter- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, 1 shall-not employ any person In such manner to became subject to Workman's Compensation laws of?California." Signe ------•--•---• ......... Owner I BY • -- ------ Title - ------ -----------• •------------ ---------------------.-..... (If other owner) FOR DEPARTMENT E ONLY APPLICATION ACCEPTED BY �... - -- G- lriJ DATE_,, ------------- -BUILDING PERMIT ISSUED .`:........................•-----•---------------------- ........----------- --..:,,--`�------------.-DATE --------...-----------------._...... ADDITIONAL i COMMENTS ......- ------ --•-•-------•-•---.............................. --••--------•----..-..-----.-.-.----•------------ -- -------------------- ................ --••--.._....._. ............ . ...............................I.....---• -------•---- ------- -- dt. ..., ---------- ---------- -••-r---------•---..._-•------•-------- •------------- yr -------- Final Inspection by- --- --------------___-_.1_---------------=-••-•••--•---•...................... -----........Date _. EH 13 24 1-68 &v• 5M SAN JOAQUIN EOCAL`HEAL _ DISTRICT 8/74 3M ., er