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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ' Permit No. .. ............. �5- ,:...._-. -_--. --- (Complete in Triplicate) - .. Date Issued .......^�rz�• ..---•-•• .................... y This Permit Expires l Year-From-Date Issued 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.-mode in compliance with County Ordinance No. 549 and existing Rules and Regulations.- JOB egulations:JOB ADI)PESSAOCATICIN .. ...7.?7.�. J C3 _+.�.. cf �:.:.._ ............................CENSUS TRACT ................ Owner's Name ......................•....•---..........._ ..................Phdnfe _-� `/63 ?.:..... S ��.dc �. +2 - Address �_f_...... City t t Contractor's Nome .. •[. '_v'�s�!1 ._. &. --...License # one Installation will serve: Eesidence-%-Apa-rtment-House��-omm-erciall!lTrciller CartMotel E]Other ---------------------------- •-•---•-•..Number of living un`its:_..._ umber of bedrooms .__si_...Garbage Grinder ..__li_rLot Size .. ;. 1 ............Private ❑ Water Supply: PublicZystem and name ------ a.f.. WdFf 1'-C�_...-'------- ---- �........................:.. y 1. t Character of soil to adept' ol,3 feet: Sand❑ Silt CJS Ci'a} i '° Peat❑ Sandy Loam 0 1 Glay Loam Hardpan ❑ Adobe {g Fill Material __.. .......If'yes, type ----- -- -- ------• - I (Plot plan, showing size of �t, location of system in relation,to; wells, buildinI If gs etc. must beplaced on reverse side.)-,\A � No septic tank or seepage it permitted if public sewer isvailable within600 feet,) � NEW INSTALLATION:; l pp i PACKAGE TREATMENT ( ] SEPTIC"TANK{ ] Size...............................111-1.._._-----_-- Liquid: Depth ........._....... ........... Type .................... Material................. .... No. Compartments ...................... Capacity ...............1.._. yp ----- is n' -•'� i X" ....... oundatiori . . Prop Line Distance to nearest`__1'1V�1� ----l-------- -----•-• - Total L n th LEACHING LINE No. of Lines 9 g [ ]; ••--------------:----.__ Length of each line-- . 'D''Bax ... _.. Type Filter Material ......-Depth ` iterL"TVLa erial ...._----- ••-•-• Distance to nearest: Well -__..... `ti 1+. Foundation -...' .................. Prop bled Line ......................... € --�-------- --- Diameter _... .:...' .. Number .... ... -_--•-- - Ro k Filled Yes (] No t❑ i SEEPAGE PIT [ j Depth oc d Water Tonle Depth _ ....-•-••.......Rock Si# .....------•---•-••----...1 ... ..._._.Foundation Prop ,Line .__.__•_•.- Distance tJ' nearest: Well . REPAIR/ADDITION rev. Sanitation Permit 9 .................•-•••• Date _.. __......:.._...•••......._•.t i I Septic Tank (Specify Requirements) ----------_-------- --------/-- ---------------- 1 ------•-----•- F.. ... ._..._..._..__..__... Disposal Field (5peci#y Requirements) .--•--.. --�tl --ill------ ........ ......•--•--------.i- . = - E -------------------- _...... - ---------------. ..-----........... ........... + (Draar existirTand re ired additibfi-6r#re rse side. application and that the work wilt be done in accordance with San Joaquin I hereby certify that I have prepared this app ' : County Ordinances, State Laws, aria Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature Eertifies the following: "I certify that in the performance of the work for which this permit is issued, I shall not ernplor any person in such manner as to become subject to Workman'`Compensation laws of California." Owner Signed Signed _ ...................................... I ' ------- • ........ ;fills ---h ............................ ..................... By ...... �. . ..-_: (if other-.than owner) 1 FOR DEPARTMENT USE ONLY i APPLICATION ACCEPTED 8Y ....j_ .........•... DATE ....�..._ .. ...."................... BUILDING PERMIT ISSUED . --•:.. - :... = DATE ..._r..................................... ...- ADDITIONALCOMMENTS ..................................................•-.......-..........-...............------........................-----.:...... l .......................................__ -- •- .•--........._I.............' ........_._......t.............-- ••-__..--_:.... .... •-------- D t .......................................r �-- J --------- -•......t • Final Inspection by: I ' ' SAN JO QUIN LOCAL ALT. DISTRICT 11 24 , n..., r.i 7172 3 1'4 �