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' �APPOCATION FOR SANITATION PERMIT =" I Perm' or �� r.. � (Complete in Triplicate) � � i t' Dat Issued _7-"_-_` � -------------------------•----------- -------- ----------- This Permit Expires i Year From bate Issued.--tl - �n _ Application is hereby made to the San Joaquin Local Health District for ato; of �P p�l-tt Ap Y q permit to"construcf and install the work herein described, This application is ma i compliance with County Ordinance No.:549 and existing Rules and Regulations. } �' AC ----1` ---�--........ - - =CENSUS TRACT �� ^ Owner's Nae _di� © ' + -✓ f_ _ ^-_i_ i' ,I _Phone ' , Address ------------------------------------------------------ C I -------------------- City --- -i. � 4----------------------------------------------- - tors Lice;nse # .---------- Phone K Installation will serve: esidence ❑Apartm@nt-House-❑-Commercial'kTrailer Court i❑ l±I N 10 ERi 1�Q Uri L I Ti F-� � ° L12-,0r CROWS ��rC kb- Motel ❑Other .......'-- ------- '- .,. e ------------- Number of bedrooms ----`#-- Garbage inde >_""'` I of Size ------------------------------------....._-- Water Supply: PublicSystem and name --------------------I------ '----------------- ----------- t `' ------Private N ! A f„ I f Character of,so'rl to a depth of 3 feet:, .Sand'❑_ Silt❑ Glay ❑ Peat❑ 6 Sandy Loam Clay Loam ❑ T _ Hardpan ❑ Adobe-E], Fill Material _- If,yes, type;------- (Plot plan, showing size of lot, location of syst lin re'lotion to wells, buildings, etc. must be placed on reverse side.) p NEW INSTALLATION: (No septic tank or seepa a pit perm fled if public sewer is av 1 •ble within 200 feet,) � '. . PACKAGE TREATMENT { ] SEPTIC TANK [ ] L'Size__.______f--------------------____'int .�r. -- :Liquid Depth ------ j-------------- Capacity -------------------- T e --------------_____ Material-L--------__ -_--_-- No. Compartments Distance to nearest: W( 11 ------------------------------------Foundation ---^------------ Prop. Line .--------------;_---_- LEACHING LINE [ ] No. of Lines _________________ ----- Length of each line_f,_ _y►y•_____�l ____1yi Total Length -_-_-______s_r_-__•-----____ 'D' Box ------.-- Type Filer Material -="--- ----- ------Depth Fiffer ateriaf ---------------------------------------- 'D' -------_--F•--- -•---� - i _ ## - . Distance to nearest: Wel ------------------------ Foundation "---.-_- --- -----`--(Property Line ------- --•--------•- SEEPAGE PIT [ ] Depth _____-_-----_______ Dia eter _______________ Number -.__F-____ --- _'----- 'Rock Filled Yes ❑,, No I❑ � Water Table Depth ------ - ----------------------------- --------Rock Size -------------•---- Distance to nearest: Well --------------------------------------Foundation ------ --"------- Prop. Line ------••--.•-----__-_-; J3 sv V }---------- IR ADIQI'I'lON Prev: Sanitation•Permit# __________________ ____________ _ __________ Date __________ t3 1. Septic Tank (Specify Requirements) --- ?----��?�t_'f(_QtV-( -�`------,�-�f0_l_f�I1t J ._'--- ------ }-t ---------i + • ['�� , st. rt ,fit � ! Disposal Field (Specify Requirements) _F�_i_�1__►VL_______ _C4... _N�'`_-_S <________________ - P 1` r -�C ! ^ C#�d�NSC �' ---------- ----- J ----------- - ---------- ---� - 9----10 NNE = -W -1'( .' -_ _ _ � � 1'_ 7 .17 •° -' t/tE (Draw existing and required addition on reverse side) r I hereby certify that I.liaye prepared this application and that the work wilt;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 sig u certifies the following: ' : $ I certify that in a perfo ante of the w r for which this permit is issued, I shidl not employ any person in such manner f R ! ' as to beco bject t sati.on laws of California." Signed D<------- - - ---------------------------------- Owner € BY ---------------------------------- j0":_ Title ------------------------- (if other than owner) FOR DEPARTMENT USE ONLY I i APPLICATION ACCEPTED BY--- BUILDING PERMIT ISSUED ---.�-_--(: . !DATE ------ --------------------- --------._:DATE --------------------------------------- ----ADDITIONAL-,COMMENTS _ r `------I--------- I f -- --------------- 1 r -------------- r .y { _ t Final I �- t - = --_----- ---�---- -------.Date -- SAN JOAQUIN'1OCAL-_HEALTH rDISTRICT - ~ "�-_ . _ E. H. 9 1-'68 Rev. 5M