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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. --•�••�••................-•.••- ...._ ...... This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Lotal Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ......Pre 5/��..............CE:NSUS TRACT .......................... - - Owner's Name .._. 1. �� .�� ----•.................................•............_•--- --.--....Phone _. ................. Address ,..., ,31�1... �f/—%�..-. / ........................... .-----•--- Contractor's Name --- �/.. ."1 i ®✓ ----------- ----- .........License #,r�J�. ./�- Phone ............................. Installation will serve: Residence Apartment+House-Q Commercial DTrailer Court [] Motel'[] Other .......................... ._._._....._.__._ Number of living units:....!..... Number of bedrooms ..y...... g a ._.Garbe a Grinder ��- Lot Size Water Supply; Public System and name'`_. ,0&0&#--i -- --. --•----------__------- ------- --------Private 0 Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay 0 Peat.0 Sandy Loam 0 Clay Loam (] Hardpan [j Adobe 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.) NEW INSTALLATION: (No-septic-tarik or seepage pit-permitted if pub`I sewer is available within 200 feet,) L PACKAGE TREATMENT [ ] SEPTIC TANK Size_. 011 XK4............. . ...... Liquid Depth W""� O ( •. •....... capacity�j��....._.. Type) _. IVI+Sterial '..-_ U •� � YP � �lJ'(f No. Compartments .�.:.............. Distance to nearest: Well .11.?b ..............I.,Foundationv-Ae9 . ....... Prop. Line .._F-.f- i LEACHING LINT: No, of Lines Length of each line ... '��. Total Length _`.:2A_..____._.. Type Filter Material YP Depth Filter 'Material . ................j`'_.__........./ Distance to nearest: Well ...... Foundation ��.:_...._._., " Property Line .. S*eFAGE^PIT Depth Sf.. ..':_..-- "Diameter`f�J /G�_- Number ...... .... _.._.. -l"-Rock—Filled Yesg No [} v Water Table Depth ..__ v------------------ --....Rock Size -.- .. - 7 Distance to nearest: Weil •___-- -- t -�` ..----Foundation _./�.�- .... Prop.Prop. line -..�►�'.�..-•---......... REPAIR/ADDITION(Prev. Sanitation Permit# --------------------- -------------_------- Date ------ Septic Tank (Specify Requirements) .. . ............. .................... ' Disposal Field (Specify Requirements) ...................._. _ r ---------•------------- -----------------.-------.---- --------------------------..----------------- .......... ......... (Drciw existing and required addition on reverse side) ' I hereby certify that I have prepared this application and that the work will be donein accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local,Nealth District, Honig owner or licen- sed agents signature certifies the following: r .� "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 Workman's Compensation-laws_of,.California." Signed .: .. ................'-....... ----------.- Owner { BY .... .................................. Title . . :. other than owner OR EPA USE ONLY APPLICATION ACCEPTED BY -_ } C - `� J - DATE .:./..:Y. /. , BUILDING PERMIT ISSUED ...:`... .......... ........... . .. _. .--� - -�---� -• ............--- -------- ---- - -�............DATE . ---.- ....--- `�-----... - •-------._... ADDITIONAL COMMENTS ....,. -------------------- -------------------••---------------- ............................................ .............................. :::::::: .-::::: :.. :::.----. -. '-=-•_ 1. .. ..� .`... :::: ::::::: ::.......: ................... _................... . .--- --------'-•-- .....-- ------- ---- --------- ina Inspection b : . ....... .- _...----Date ....1..`. SAN JOAQUIN L CAL. `HEALTH DISTRICT E Ft 13 241-'68 Revue 717? 1 u