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FOR OFFICE USE., lt� APP..LICATION FOR SANITATION PER t. . --- -L------ ----- (Complete in Triplicate) Permit No. -- -------- This Permit Expires 1 Year From Date Issued Date Issued Application Whereby made-to-the San_Joaq.uin.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 existing Mules . egulations: JOB ADDRESS/LOCATION ' .___- � � � ' ------ ---- ---------------CENSUS ACT --- =Owners Name ----- Phone - ' 7.. . Address -------- ----------- -- - -- - ---Y.--- ------------------------------- --- City �_ :may ----- _ -------=--------License,#,1CO % - ----- Phone 6 �7 Contractor's Name '�.......... ..... �- '- , Installation will serve: Residence fApartmen#House❑ Commercial❑T aalar.C�urt ',❑ f i�1 � Mote ❑Ofher ---_------- -' fZ------ ---- - --------- -i 11 'Number/ � f� q Number of living units. ----- Number of bedroom s. ,_1�_Garbage G "nder --_-_ t Size ---L_�__X_..J__ `Q....__...___. Yf - - {Ii -- -- { Water Supply: .PublicLSyst ma`ndname __-_:_--._._ Pedt Sand �E-oam Private { Character of soil to a.depfh af.3;.feet.", Sand'[] Siit ❑-,,,,Clay ❑ [ y ��❑ Clay'Loam;❑ Hardpan ❑ Adobe Fill Material ---- z f yes, type �--- _____ I I (Plot plan, showing siz o�t;�-lscaion-of�,syst-�emY in relation to buildings,utc. must be p!a ced,.�or,>yrev`erseFs�ide.) NEW INSTALLATION: (No septic-tank-or seepage-ppif permitted-if-public sewer is available within 200 feet,) PACKAGE TREATMENT {�] SEPTIC TANK[ l i Size - ��+ Liquid Depth ----------- Capacity TYPe Material--_;. ---------- . No. 9 ompartments -------- ----_----- fiDistance to nearest: Well ------------------------------------Foundation .....--------- -....-- Prop Line -----------------_---- t LEACHING LINE/'[] No. of Lines ------------- ---- Length of each line------ --------- ------- Total Length -----------.--_.-__-_._-_.-- �. 1 V{ 'D Box ------------ Type 'Filter,Material --------------------Depth Filter Material --------------------------------•---•------- � D'++stance to nearest: Well ________________________ Foundation I------- ------- Property Line. ---------...._-.________ SEEPAGE PIT311"t.1 I Aepth --------------- Diameter ---------------- Number ------- ------------------- Rock Filled Yes ❑ No 0 WaterTable Depth ------------------------------ --------Rock Size ---------------------------•---- Distanceito_nearest:Well -.------------------------------------Foundat,ion---------:----�------ Prop. Line --------------_-_.-- t �. REPAIR/ADDITION(Prev. Sanitation Permit# ----- ------------ ------------------------- Date t--------------.-----------------I i Septic Tank (Specify Requirements) --------- _ _ I ----------------------- - ------.-------------- -<.------ -------------------- t Disposal Field (Sp cify quire enfis) __--_____fi c-e-�-"[ ----- --------- 7,5- ------------------------------------ ,------- --------- ---------------------------- ------ - ------- ----- - ._ ----------- ---- -- -------- {Draw exist `g and r6guired addition on reverse side) I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin i 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: "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 laws of California." Signed ------------------------------------ ------ I---- ------ Owner -------------- Title ------- - ------------------ (If other th owner) I FOR DEP RTMENT USE ONLY _ _ _ . I `€. APPLICATION ACCEPTED BY -----�L�1.��.._ ._- -- - -------DATE_--�/-�=.Z��..=..� - -------------,_ BUILDING PERMIT ISSUED ` ' -- --- ------- DATE ------------- ---- ------- -- ---- - ADDITIONAL COMMENTS ----; ----lL.r�'.G. 4-_V.- - ------ ,-A?✓YL4----------- -- ------ - -------------------------------------------- -------------------------------- g, ----------------- - --------- ----- -------------------------- ------------------ --------------------- Final InspectionbY - _ = � ' Date -� __'" _`. . ---------- ------------ Final JOAGON LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.