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- FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT —7 fPermit No: ----------------•---------------- - (Complete in Triplicate) --------- ------------ --------- DoteDate Issued ----�- Z This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION-YV----- f ------------------------- 0S -: 2_ - . CENSUS TRACT ---��_ 7 V-----•• Owner s Name _SARA-�--------�--p � ------- ��rc�• i�_It} ------Phone ---------------------••------------- ry Address . �_ -------------------------------- - -------A4-�l�-------1767--------------• City ----i�xsc&9 O � � License # Phone ----------------------------- Contractor's Name ------ -------�:-- - ------------------------ ------ --- ------------ - --------- Installation - t Installation will serve: Residence Apar'-finent House❑ Commercial :❑Trailer Court 1',❑ i Motel i�OOther-- --------------------------------------- Lot -' � F y - t Jf. Number of living units:_ .)---- Number of �edlr&ms --_, P Garbage Grinder A / --- -41 - Lot Sipe - - --�- - f - ' -' ----Private ®� y .? ----I - ---- ---- Water Supply: Public S stem and name - � r Character of soil to a deh of 3 feet: Sand' V� _A6616E�Ej-❑ Gay ❑ Peat ❑, , Sandy Loam Clay Loam ❑ "� sJ?u/ - - Hardpan Fill Material"_ ''If yes;type'- _" --------- •�- rj (Plot plan, showing size 'of, lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.411 11 l NEW INSTALLATION: (N6 septic tank or seepage t permitted if public sewer is available withi 200 feet,) PACKAGE TREATMENT [ SEPTIC ANK'[ ] Size------------------------------------------------ Liqui Depth ----------------•-------- Ca aci Material---------------------- No. Com artments ---.----__.__.-_.----. P t'-- - Type Dist�cei to nearest: Well - -------------------------------- Foundation Prop. Line -------- LEACHING LINE__[ ], Nlo. of Lines ------------ --------- _.Length-of each line---------------------------- Total eng#h ---------------------_--- i 'D'i Box -----------�Typr aterial _- ---------Depth Filter Material --- ----------------•=----------•-• - v Diame r -------- Number --- ------------- -------- Roc r Line l Distance to nearest: Well --- --- Foundation _ Pro ty \ ` 4 1� _ Filled Yes ❑ No .i❑ [ ] ----Depth ------------- ----- * — Rock Size ----------------------- -------- SEEPAGE PIT # �': , mater%Table Depth, Distan ce to nearest: Well -- Foundation ----------------- Prop. Line -------------- ......------------------------- REPAIR/ADDITION(Prey. Sanitation Permit ---- Date ----------------------------- Septic Tank (Specify Requirements) ___---- ---------- '. x �bisposal Field (Specify � s 41 - _ - (6raw existing and-requireclaalditiarion reverse sideJ""""`�" I hereby certify that I have prepared this application and that the work will 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 signature certifies the following: f., "I certif t in the erfor ce of the rk for whit his permit-is issued, I shall not employ any person in such manner as to bet a subje to W man's Co sat la of California." Signed - -- -= Owner ------------- - - - - By --------------- --- ----- -- - ----------------------------�ciW----------- Title ------------ ------------- ---------- (If other than owner] ;-� -- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _.-'-l. 01---`0----------------------- ` - ----------------------------------------------- DATE .P- 2--- � - BUILDING PERMIT ISSUED ------ ------ ----- -----------DATE ----------- ------------------------------- ADDITIONAL COMMENTS -- ---- -----------------------------------=--------------------------- -------------------------- -------------------------- ----- ------------------ -------------------- ---- ...v..........—�..r.....�-.. .-t—vr «_.._—�.e..�.ar�...T� --_----__-- _--•----•-- •-- =n._--.se=e_—..-w.-_,--vv__a._-_.t.__--_-'--•-_-_-_----------_ 1 - --- - - __ __ ----------------- - ---------------- ----- ---- - - ._ i' - _ --•-• ------•__,----___----_ Final Inspection --- ---- _. .._. i' _ 1 _ _ Date -� SAN JOAQUIN LOCAL HEALTH�DISTRICT' E. H. 9 1-'68 Rev. 5M