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FPR OFFICE USE: APPLICATION FOR SANITATION PERMIT ,d a 7 d ` �: .�.-rc. Permit No. ---- Y {Complete in Triplicate) ---- Date Issued/7/2 This Permit Expires 1 Year From Date Issued w , Application is hereby made to the San Joaquin Local 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 existi utes d Regulations: j1WC JOB ADDRESS/LOCATION" g LZ -14ANU T A T ` ------� Owner's Name ------ �---- Phone * � n Address __ :: .._ Flce��- ------'-'---- --� City {. f _ , l r .License # ------. ----------- -TPhene` r'r-f='' I Contractor's Name Installation , Residence Q�Apartment'House❑ Commerciale❑Trailer Court ;❑ . � r � 1 Motel ❑Other ------ 41 1 F r 777,5 L/ V V_______________ Number of living unit; _._ -. Numberl`af beds rooms --- -Garbage Gri`nde _______} +Lote _ f---- ----- t 1 ' ---Private �.--. Water Supply: Public System and name --- - -----�------ ------w----------r----- -- --�---------- ---- l '- Character of soil to a de ! of 3 feet: Sand' Silt❑ { Clay F] Peat E] Sandy Loa CIlay Loam ❑ p Hard dR 1—A-Adoise"❑"""Fill Material --------_--- If Yes type ------------- ------------- (P.,lot plan, showing size of lot, location of system-in ,relation_to wells,r�uildings,�etC. must be' placed on reverse side.) � •. i I 1 _ .. NEW INSTALLATION: (No septic tank or seepage-pit permitted--if public sewer`is available w�fhin 200 feet,) a PACKAGE TREATMENT [ ] SEPTIC TANK' Size. ` �� .d LiquEd Depth ---- ----•--- -- ; y 13 M' ;-- , r� o. Cori, artments �_ -::....--••-- � { Ca deity c _- e ----- Material - _ . p r , p I Yp .c7Or I oundation�- ._ Prop. Line �._ Distance to nearest: Well LEACHING LINE .,No. of Lines ____ tl' t- ��ength of each line.__ v-- - Tota Lengthy 3---- - -• 3�, [ I "' ry �r l / rr u i D' Box ._- ''`_ Type Filter Material -- �---------Depth-Filter—Material `--- •-------- I i Distance to nearest Well ___ /000=-�=- Foundation _._3----------- ---- Property., e ----✓-• --------•-•-• SEEPAGE.,,PIT Depth Diameter ---------------- Number ---- ----------------------- Rock Filled'-,Yes ❑ -No i❑ f Water Table Depth ------------- --------Rock Size _ ,. r1----1- VV Distance to nearest: Well ------------------------------------------Foundation -_---------------I Prop. Line ---•-----------• ---- REPAIRfADDITION(Prev. Sanitation Permit# .-------------------------"- Date ---------------------------------- } Septic Tank (Specify Requirements) -------- ---------------------- ----------------------------------------------------- A� . yf Disposal Field (Specify Requirements) --'-------- --------------- ----- ------- ----- - f r ----- --- ----- ! - - -------------------------------------- --------------- --------------------------- ---------exist=- ----- -- --uire- - -- -.z1 {Draw existing and required add ifiion on reverse side} t I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin f County Ordinances, State Laws, and Mules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies 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 la of California." Signed - -------�-- - -��--� - ------ -- Owner ITitle -------- ---------- ------------------------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY ------`.S'e`w-------------- ---------------------------------------------- -------------------- DATE ------ ---`--- "'��-------------- DATE `---=------- ------------------------- BUILDING PERMIT ISSUED ------- rte- ------------------ ------------------------ ------- a ADDITIONAL COMMEN. S F _. -- ---=- --------•-_-- -------- ---------------- ----------- f ._ dam.- --------------------------- ------ ----------------------------------------- ------------------------------- ---------- --- .;'�: - ------------------ ----------------------------- --- ------------------------ - - ----- - ------------ ----------------- --Date --- -.7- ------------- . Final Inspection bY: --- - -�-- x- --------------------------- --------------- i SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M