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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No: ------ (Complete in Tel ' Date Issued _4.7,* :4 This Permit Expires 1 Year From Date Issue cal Disrict for a rmit to construct and insal the work herein Application is hereby made-to odSSan in Joaquin wiHh Cou tytOrd nan a No. 549 and ex st ng Rulestalnd Regulations: described. This application s ------- CENSUS TRACT --------------•-------------- JOB ADDRESS/LOCATION _.. ` --- ----- ��----�� --�4�,4ar1�_-. city/-------------------- -------- ---------=---- ---------------Phone --------------------------------------------------------------- . Owner's Name ------ - ,--------- Address ----------- - - ----------- '/ # ---._ '._/�4�� b5'� �� q _ Phone --------------- Contractor's Name ------��-,'-' 1.---- ------------- -• -- - License ` Installation will serve: Residence [g Apartment House❑ Commercial ❑Trailer Court l❑ \ -- Motel ❑Other -------------------------------------------- Number ------------- ----------------------------Number of living units:--- ----- Number of bedrooms -_ ----Garbage Grinder /W__- Lot Size 4e�A C-' --- --------•------------------ --------------------Private Water Supply: Public System and name ----------------------•----------------------------------- Cla Loam Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat El Sandy Loam ❑ Y' O Hardpan ❑ Adobe [IFill 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.1 i NEW INSTALLATION: (No septic tank or seepage pit permitted if public available within 200.feet,} PACKAGE TREATMENT [ ] SEPTIC TANK Size er' / .40 Liquid Depth - � -_ T m,4_9�� Materiale�ae��---- No. Compartments _�-----•-�•--- .'� Capacity,r .r _+�+�- Tyr -- - ------------Foundation .-/V-� p - Pro Line ---�---•-------•- Distance to nearest: Well _ � --- < »s LEACHII�IG LINE No` :of Liries Len thof each line.-- r� Total gth ---- -- ---------- Len g Ar YP al: / —Depth Filter Material f.._-.._ Distance to nearest: Well oZ Property Line --.r - ------------- -�` `D' Box a S-_ Type Filter Material t 1 Foundation ---a- N Ir mbe " Rock Filled Yes No !Q Y r SEEPAGE PIT �Q Depth '�---. -�, 'k. � ----- t € Diameter - - f Water Table Depth-- _ Rock Size -=-- ---------- Found'ation -- �`...- M f:F - -------------- # ..6 }Prop Line -a�f� Distance ta-nearett:"Well ---_ -- -t��- .�� t 4- Date - 3---- ) I REPAIR/ADDITIOFJ(Pr ev Sanitation Permit# --------------'--=------ - N � ,.. ------ --------------•- f_ t r Septic Tank (Specify Requirements) -------------------- Disposal Field(Specfy Requirements) ----------------- ------------------- - r - - ---- -------------- 4 ----�-� — ----- --- •-•-----4••------ - x (Draw existing and required addition on reverse side) 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 certilfies the following: ) "I certify that in the performance of the work for which this permit is issued, II shally noot4empl�oi any person in such manner q as to become subj ct�to Workman's Compensation laws of California: Owner Signed ----------- - ------------- ------- -- By -----`-4,- ' Title other i 6wner) . FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - - ---.----"--------- ----a�------------------------------------------------ ------- - - - ------------ ------- --------- ------------- DATE - - --2-6- -----•�------•------- - BUILDING PERMIT ISSUED ------------------------ -------- --------- - = ------ ---------------- ------------------ ----- ------- DATE -- --- ------•--------------- ------------ ADD ITIONAL�COMMENTS --------r-- --- --r-y --- ---- °--------- -------- ----•--- ----------------------------------------------------------------- -------------------------------- - ---------------------------- ------ --------------- ----- - ------------------------------------- -- Date------/-.-_L--z-------------- -` , ; ------------------:-- ---- ; -- ----'---- -----=- ----------------------------------------------- -------------------------------------- ------- --------- ----- ---------------------------------- Final Inspection b SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M