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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT II {Complete in Triplicate} Permit No. -l--..-.9_�. -_----_________.____ This Permit Expires 1 Yedr,From-bate.lssued Date Issued -----------------------I------ _ Applicati' n is.hereby made to the San Joaquin Local Health District for�atpermit to construct and install the work herein described. This application is made in complicince with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LO ION ._ 1_ --------------------------------- CENSUS TRACT --•-------------•--•---_ Owner's I'II Name - - Phone ---- - ---L .�__ _ --- -- - --- /j� Address �------------- --SzF-------. Cit -- -- --- --------- ---•-- �, Contractor's Name ----_ -� k �. /� # r ((�G4 Licens #h- 1 Phone Installation will serve: Residence Apartment'House❑ Commercial-®Trailer Court ❑ - - ------ Number - -. Motel[`J-,TOther,_ _��'[Plt�'zl!�--s_ � f of living units:. {`'Ery Number of bedrooms _----_--__LGarbage...Grinder_-- _----__--Lot)Size ---------- --- -----__-._--_-------_-Water � Number ! � � -� - Pply' Y e ^ r:f f�;i:.s�. ,r,.. •--_ . ...Private Public S sptem and-nam Character r -«---- ---- i -----�;y ;-,� °-�=-------=------------------ • ;-- of soil to a depth of. feet I Sand'❑ Silt `^>61 PecI Sanity Loam Clay Loam n-El Hardpan❑�. Adob i"❑ Fill Matenol'i`-- -'If yes;type ---------- '*~*"""�"""S (Plot.plashowing size of lot, lo tion.of--.system!in,relat.ion._to-_w.ells._b ldings,_.etc..-must e,,placed�on'-reverseRside.) Q NEW INSTALLATION: (No septic tank or seepage pifi-permitted if public sewer is available with in'200feet;),o PACKAGE TREATMENT ( ] SEPTIC TANK[ ] Sizer------------------------_--°`- -----_-_ -_ Liquid Depthk--,W-_.--_--_----,_.._. Capacity -1-------------•-- Type --- Material Na. Compartments Distance to nearest: Well,-`=:---:_�___.-A15�.: .____:_Foundatici� ___._}'------__-__ti Prop. Line ----------=-------- -- LEACHING LINE [ I No. of Line _.___,____________-- Length, o ach,l ne�---._-_-._-_ Total Length __---_-_---_-_ D' Box ------ Type Filter Materiel ___-_ ----Depth Filter Material --------- ---------------------------------- ij Distance to nearest: Well ------------------- ___ Foundation -------- Property Line ---__---..------..-.-. - i SEEPAGEIPiT [ ] Depth ___�_________._____ Diameter."t_1, __ r'Number .________ ._____ �' _ hock Filled Yes '❑ No i❑ yr ".,, . 1 ' Water Table Depth ---------------------- ----------------Rock Size A -- ----1-----•-- � � V Distance to nearest: Well ____________________________ ___ =__"Foundation t ` Pro Line _. ----.-_ _-_---. DDITIONSanitation Permit# _______________----------------------------- Date _-___-°_____- _.._ REPAIR A - � F � ) --------- Sep •� F ��"' Setic t (Prev.( �------.�^._--------- -_ - ---- �- p Tank (Specify Requirements) ------------- I _________ . _ " r > r - ---------- ---- 1 ; Disposal Field (Specify Requirements) -60 --X- --- = � �� ` ---------------------------------------------------- , � T t _-� i (Draw existing qnd-required add fior}o'rev"e fee �de'1 I hereby certify that I have prepared this application and that the work will-bedone in accordance with San Joaquin CountyO'r'dinances, State Laws, and Rules 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 Signed become subject to Workman's Compensation laws of California." i g ---------------------- ----- ------ __ Owner QJ"-_4.A -- ---------------------- By ---------='----- - = Title 1-- - - ----------------------- (I other th owner) '' € FOR DEPARTMENT USE ONLY t APPLICATION ACCEPTED BY ---. DATE AI~.a6-�/ BUILDING, PERMIT ISSUED ----------A---------------------------------------------------------------------------- ------------------DATE ---- -----------------------•-•---------- ADDITIONALCOMMENTS ---------------------------------------------------------- ----•--•------------------------------- ------------------------------------------------------------ 4 ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------- It---------------- --------------------- ------- ------ .. F _ ., Final Inspection by: ----- ---------------=------------------�`-----------------'-�-"_.-----------------------------Date .� --�---�'-1----- -- - - t SANyJOAQUIN LOCAL HEALTH DISTRICT 't..4 E. H. 9 1-'68 Rev. 5M „�