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FOR OFFICE USE: Y T ^�"` --------"----------- ------------------ ----------------- APPLICATION FOR SANITATION PERMIT ----------------• `. ----------- (Complete in Triplicate} --------------- . ... -- Permit No: �� /z `-------- This Permit Expires 1 Year From Date Issued Application is herebyDate Issued I-Z--� " 7 described. This application made to the San Joaquin Local Health District for a is made in compliance with Count permit to construct and install the work herein Ordinance No. 549 and existing Rules and Regulations: J08 ADDRESS/LOCATION .111.1 � - � � l � Owner's Name 1111 - ` - �--------- F � /%[fir:---i--- Ll�j �i _ /---• Address -- p- t�, Ir'} : y=�" � '�"-" Phone TRACT ------ og - ---- -- --------------- Contractor's Name ._- - ' ------ ----•--. City -SACC r-�-h_� `to ------------- 'Installation will serve: _ partm -- ----- 1 `T Residence q F Commercial dTrailer C Phone _ G4 License # _ _lo_�j _ ❑Other' enc House - _ `~ 1111-� -- Mote! ourt '; Number of living units---------- -- }' ❑ M - - � • Number of bedrooms -1 --Garbage Grinder _- - __ Water Supp(y; Public System and. name _ Lot Size --.rs^�/ A Character of soil to a depth of 3 feet:. J_____ " -�•-- CC �� -----1111-- �`'�[ l Sand lit❑ Cla ----- - - ----------------1111-- -- - Private � Hardpan Y Peat(] Sandy Loam ❑ Clay Loam.� ❑ Aldobe �I f� Fill Material -_-- -- (Plat plan, showin ` If Yes, type ---1111-- g size o{��Iotcation of s to NEW INSTALLATION: - -, rrlir"relation toils` buildings, etc. must be placed an reverse side.) (No septic tank or seepa"g"e -1 it permitted if public.'-sewer is available within 200 feet,) r ' PACKAGE TREATMENT N [ 7 SEPTIC TANK: Capacity --�` _S- -- ------- - - TypeLiquid Depth _'7--------- " Material Compartments f — Distance to nearest: Well LEACHING TINE - __ _ . . ----- ---• _Foundation --'--- ----------- � No. of Lines L'en th' FoF i _ - Prop. Line --------- g each line--- -- Tota! Length --'ltd_ " D' Boxy_ __ Type Filter Material I _ ��__:Depth Filter �Materiai rr Distance to nearest: Well ----- r ------------ --------------------- ---------- ` SEEPAGE PIT-. Foundation -----L._4 f _--� � Dep ` Property:,(Ine 4 , No .. �.,.� - t�-- -----�- Diameter ��- 1111- Numbelr --- � ' 1111 #---1111__ Rock Filled Yes 0 Water'Table Depth', - �--� `� ��-- •-- ;f Rock Size Distance to,nearest: Well,+-_--__i -------------- I_-,---------Foundation �� REPAIR/ADDITION(Prev. Sanitation Permit C# ______'._____- _ "" Prop. Line ...........------- --------------- .... . --------------------1111-- - Date Septic Tank (Specify Requirements)-n-- - l --- 11 11--1111-- 111111 11--1111-- Disposal Field (Specify Requirements) -------------- F 1111 - - - ---------------------"---- ---- -------1111--•- -------------------------------------------- ------------------------------ - 11 11-•----- - - --------------------------------------------------------------------------------------------------------------- (Draw existing and required addition on reverse side) E ---------------------------------------- I hereby certify that l have prepared this application and that the work will be done in accordance with San Joaquin I 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: G "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." - - T- tT� • y Signed ----------- -- - - - 111111 11-1111-- -1111-- ------------------------------------1-- Owner BY ------- ---- �- - f (!f of 'r fi an owner) --- Title --- ll O PAitTMENT USE ONLY APPLICATION ACCEPTED BY _, BUILDING PERMIT ISSUED ��` ----------------`----------------------------- - DATE . `-- -------//------------- `1 - - -- ------- -�`--------------------------DATE -------------•-- ADDITIONAL COMMENTS -•.- _-�-- --- --------1111-- 1111- -- � -- 1111- -1111-- - ------- - --- --- - - -- - --------- ------ --- 1111- --1111-- " --------------------1111-- --- -------,�- -- 1 111-1111-- ---- 111111 11--1111-- - 1111- �a - ------ -1111-- --1111-- -1111--- -------- -------------------------- -6 --- ---::-:=________-..------------------- - 1111-- -1111-- Final Inspection by: .-- _ - --- - --- - ---------------------- ------------------------ ---------------- --- ------------ ------------------- ---•----- .i - - -------------------1111-- 1111 ---•----- --- --- - ---1111-- -------,Date --- AN -N J AQUIN LOCAL HEALYH DISTRICT _ E. H. g�� T-'68v. 5M✓