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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT f_ Permit No. ------------------- i� _ -------------------------------- ------------------ -"-- [Complete in Triplicate) ------------------- Date issued " = �� This Permit Expires 1 Year From Date Issue -. ------------------------------r ---- -•----- i�. A lication is hereby made to the ean compliance ec wial th Countyealth e rict for a No. 549 and existing Rulesermit to construct and intalndt Regulations!he work rein described. This application is ma p O1�� G � •� CENSUS TRACT --------------m----------- JOB ADDRESS/LOCATION } -, , -n ' P--on `- ---------------------------- O?7T-- Owner's Name ____-_ r r `� Cit ,fir ---------- --------- Address -" "I ---- t __ _ "License #///. '��►" Phoney r�d•_,�r '/ Contractor's Name -------------------- "-"""--"" - Installation will serve: Residence,,$Apartment House°❑ Commercial ❑Trailer Court i❑ Motel ❑Other ----------------------------------- -------- /� / Number of beds ms $ Garbage Grinder*l0""- Lot Size ! ��- '�---------- Number of living units:-.---- vat ❑ /, Water Supply: Public System m and name -- Clay Loam _❑ Character of soil to a depth of 3 feet: Sand'❑ Silt O Clay ❑ Peat❑ Sandy Loam ❑ Y k Hardpan ❑ AdobeJ Fill Material _____.____" If yes,type _-"" ------------------- - y ` buildings, etc. must be placed on reverse side.) (Plot plan, showing sizer, of lot, location of system in relation to wells, NEW INSTALLATION: {No septic tank or pit permitted if public sewer is available within 200 feet,) r / i � �i /� !�a ------- Liquid Depth - -•------------- Size- SEPTIC TANK, -" " PACKAGE TREATMENT Ii ] �g-No. Compartments I�� TYpe� /'-__ Ma#er�al o - .._.-. iCapacity i �u - ------Foundation Prop. Line _ --- Distance to nearest: Well __-- _"��-- -------- / Length o feac lin ---- Total Length ---------- I LEACHING LINE � iNo. of Lines __A----------------- g �+ 'D' Box �/t19 -�TYpe Filter Material _Depth Filter Material -/R------------------ Foundation --------------- Property Line. ------------------ Distance tonearest.. Well _ � Rock Filled Yes No '0 ---- Diameter --- Number __._ ------ SEEPAGE PIT Depth ti Af - ------------ I it , "� Rock Size. '� ---- Water Table Depth ---------------------------= ------------ - 440 i 1� - Foundation REPAIRJADD1TlON rev ---------- Prop. Line --- --------------•- Distance to nearest: Well - 047----------- ? Sanitation Permit# ------------- ------ - ------------------- Date ----------------------------------1 --(Pil Septic Tank (Specify Requirements) ---------r-------------------------------------------------------- -------------- :----------------------- - Disposal Field (Speci�Y Requirements) -------------------------------•---------------- ""---- -- --------------------------- ---------------------------- - ----------------- --------------------------------------------- --- ----- ---------______il�"- ------------------------------------------------------------------`------------------------------------------------------- "- (Draw existing and required addition on reverse si e 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 Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature ce.. ifies 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 Workman's Compensation I ws of California." Signed -------------- ----------- �� --------------- ------- Owner ----- - i� -------- -- --a - -------- --------- - Title --- --- ----- ------- --- - ---------------------------- --- (lf r #ha owner) FOR DEPARTMENT USE ONLY DATE _.__e ------------------- APPLICATiO ACCEPTED BY -- - UED - :--- ------- --------- ------------------ NG AD LD1 ONA PERMIT COMMENTS ------------------------------------ --------------=---- --- - --- ---- - - i� ------ Date ) ------~ ---- . ----------------------------------- -- --- -- -- --- - Final Inspection by: --- SAN JOAQUIN LOCAL HEALTH DISTRICT .-_E. H. 9 ' 1='168-Re - Ikk