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FOROFFICE US�: APPLICATION:FOR SANITATION PERMIT --�--- Permit No: _ - (Complete in Triplicate) f I %----------------------- --------------- p I ----- --------- Date Issued _-..�---�5~---� --------------------------- This Permit Expires ] Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and in the work herein described. This application is made in compliance with County/Ordinance No. 549 and existing Rules and Regulations- ,cation ADDRESS/LOCATION _�- l: •• ' ` � - ---CENSUS TRACT -------------------------- � / -_ A-- --- ----Phoneq-9_"/_-/__ Owners Name - fa�UC! __ /1�) ] Address �G- :'! '$A � I� Q _ 7 City - - _ o- --C - +©_ Phone'R� --------------- Contractor's Name ---------------------- Install ---------- ---- - ------.License t Installation will serve: Residence ❑ Apartment House❑ Commercial .90Trailer Court ❑ k ' I Motel ❑ Other 10Fri-C�-- �"��V*7 C. 'l.----- Number of living 'units'_'-___.'"`Number of bedrooms ____________Garbage Grinder --�=.-- Lot Size � I "� E _ Private [ Water Supply: Public System and na a _____------------ ---- -- --- - � k Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam Clay Laam :❑ Haidpan ❑ Adobe ❑ Fill Material ------------ If yes,type ----------------- --------- must buildings, etc. must be placed on reverse side.) {Plot plan, show size-of„lot, location of system in relation to wells, { ANEW#NSTACLAT'ION: (No septic tank-orpit :permitted if public ss�ew�r is availa6l�within 200 feet;))` �(` ". r;� 1 _7Y- _X 7-� -- Liquid Depth _?-----•--------•- '` PACKAGE TREATMENT [ ] SEPTIC TANK!. ��, •Size ---------- --- ^-- q p t� Ca aafi �� Yp/ = / �'IVlater.ia � N Compartments ..----o--- p Yg -------- T a _/9------------- Distance �j Foul da#-ion 1-Q------ --- Prop.!Line _/1-------------- Distance to nearest: Wells-�( �----------------- e, x o v{ Total Len th _Q_0-.---------- N LEACHING LINE [� No. of Lines �.------------------ Length of each line-/�;�r-- ------- --- g - „�� t „ 'D' Box >, Type Filter Material JLt�'_7----Depth-• ilfer Material f -- --- -----•• �, n / 07--••-------•- Distance to nearest: Weil _ ---x`41 Foundation-�------------ Property Line - - SEEPAGE PIT [ ] Depth -------- ----------- Diameter --------- Ii�lumber -- -_` -�•.. Rock Filled Yes ❑ No i❑ Water Table Depth -- t -------Rock Size ----------- --- --------------- ______________________________ i , t Foundation -1-1------- Prop. ;Line -------- ------------- Distance to nearest: Well ___________________________ .. i REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------- ~ Date ------------------ 2 I I Septic Tank (Specify Requirements) -------------------------------------------- I --------------------- Disposal Field (Specify Requirements) __-------------------------• _. .-N-!_ _______________________ ' t q i• --------------------------- -r-------------------•-----_----------------------- h F --------------------------------------------- --- - -------------------------�='-- ---------------------------------- ----! ! (Draw existing and required addi ion on reverse side) 1 I hereby certify that I have prepared this application and that 44 work will be done in ccordance with San Joaquin i County Ordinances, Stare taws, and Rules and Regulations of t ; S n Joaquin Local Health istrict. Home owner or licen- 3a sed agents signature certifies the following: 1 per an in such manner "I certifythat in the performance of the work for which this perms vis issued, I'shall not empiby any p -- as to become subject to Workman's Compensation laws of Californ a.” 3 Si ned --------- ----------------------------- Owner # gide OW ------------------ BY r ----- (if other than owner) +� FOJt DEPARTMENT USE ONLY - - , DATE---------------------- �----�---------- APPLICATION ACCEPTED BY - --- -----------=----- `` ------- , ---- ------------------- , i {" DATE ------------------------------------- BUILDING PERMIT ISSUED --..---------------------------------------------------- I I ADDITIONAL COMMENTS --------------------------------------------------- - --------- ; -- ---------------------------------------------------------- ------------------------ �; _ 1 - ] Q---- 1---t -=� _—J------------ ---------- --------]D to --------------------- - -- L �E Final Inspection by: ----------------- `: SAN JOAQUIN LOCA iALTH DISTRICT E. H. 9 1-'68 Rev. 5M ... .