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FOR OFFICE USE: f APPLICATION FOR SANITATION PERMIT A-, -^ {Complete in Triplicate} Permit No: ___-_-_____--- -_-- ------------------------------------------... . This Permit Expires 1 Year From Date Issued, Date Issued Application is hereby made tthe San'Jo qwn Local Health District for a permit to.construct and install the described. This application is made in compliance with County Ordinance No. 549 and existing Rules.and Regulations�ein o (cam [� / 3P JOB ADDRESS/LOC) TION . -------_-- -- / '3 L� 6Nj Q/� ( SlJS TRACT + f� Owner's Name -------------- _-Phone -7- : `- _2cr Address 7. - Z� ,------ - ------ Gi City �-:�' ' fly - ----------------- ------ . -- -- - Contractor's Name --__ -- C/ -------- ------.License# � . Phone �J- ?5_4 Installation will serve: Res:iden �1 �par#n5ent House E] Commercial:[]Trailer Court ;[� p�/ Motel E]Other -- -------------- --- Number of living units:------------ Number of bedrooms _______Garbage Grinder _____________ Lot Size ________----_______ _ Water Supply: Public System and name ---------------------------------------------------------------- -- -- Private 2" - - - - - ------------------------ - - Character of soil to a depth of 3 feet: Sand X Silt❑ Clay E] Peat❑ Sandy Loam Clay Loam:E] _Hardpan E] --Adobe E] -Fill Material--- =--- __-If yes, type -------------=--�--- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,} PACKAGE TREATMENT [ ] SEPTIC TANK:[ ] Size_ _ o -� v - r` Liquid Depth --=��-- P Capacity .12Q4 Type( -- MFm rial_____ .___.__________ No. Compartments �i ------ ------- We Distance to nearest: ll -------6 ________Foundption _/U____________pProp. Line -__!� ------------- V _ _ -_____ ----- Length of each line___ ___ LEACHING LINE { ] No. of Lines ------_ - ` - -�•----- - g � ��-------- Total Length [--�®- 'D' Box ------------ Type Filter Material _C'_ --- _Depth Filter Material ___/ -_----- - -- ti ---- Distance to nearest: Well ------ -------------- Foundaon f G � ' ----- --------------- Property Line _6--------------------------- 3 SEEPAGE AIT Depth -------------------- Diameter ---------------- - Number -------- --------------- Rock Filled Yes No Water Table Depth ------------------------------------------------Rock Size ----- --------------- ---------- � a , Distance to nearest: Well __________________ --------------------, Foundation __------------------- Prop. Line -------- ------- © , REPAIR/ADDITION(Prev. Sanitation Permit# ------------."_------------------------------ Date Septic Tank (Specify Requirements) ___________________•_. -- -__ r --- -- ---- 0 F ._ - - _ fir--- - Disposal Field (Specify Requirements) ____---__---- ------------ --------------------------------------------------- ---------------- ------------ -------- l hereby certify that I have prepared this application istanand ired addition e - --------- ---- ----- _ _ _ - � g q � on reverse side) .- y fY P Pa work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall not employ any person"In such manner as to become subject to Work n's Compensation laws of California." r Signed a-- -------------- - Owner l BYt - ----------- h ------- - ---------- -- ------ ------ ------------- -- Title --------- --` a -- --------------------------------------------------------- (If o#her han owner) .., f FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - y f = / DATE ----- /� --[, BUILDING PERMIT ISSUED -•- - ---- --- -- - ------ ---------- ----------------------------------------------------- - ---------------- ADDITIONAL COMMENTS _rL�/_P �- - tD q - 1 ---- - --------- ----- ----- -- --- --- Y /}L - -------------------------------------- -----------------------------------------Date---------- ---- - Final Inspection by: -------------------- -- - -- -- ----------- - --- ----- -- SAN JOAQWN. LOCAL HEALTH DISTRICT 77, E.;H. 9 1-'68 Rev. 5Mt.