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FOR OFFICE USE; S �, ` APPLICATION FOR SANITATION PERMIT -------------------------------- Permit No. F. (Complete in Triplicate) 7 Z ?Z a This Permit Expires 1 Year From Date Issued 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 made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB"ADDRESS/LOCATION ------ —-- --------------- -�"'`�f CENSUS TRACT _-._..._-.___ ----------- - ------ ----------- ----------------------- Owner's Name n---r--- ----------- Phone - ---- - - --------------- -- -- Address �. ---------- ---------------------------------------- City - 5TK, --------------------------------------------------------- Contractor's Name t - ------------------------- Phone - --- - Installation will served Residence._.❑Apartme.nt,House:Q,Commercial[ Trailer. t.�;�:�•---�- " .�. Motel F1 Other ��tJC,-_"�4�+.A1 �� ' Number of living units:--/------- Number of bedrooms ..._.._Garbage Grinder --- ---- Lot Size .J7.f=4Dt----- ------------- Water Supply: Public System and name ........09 ----------------------------------------------------------Private] Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam •❑ Clay Loam ❑ ;- Hardpan ❑ Adobe-g?—fiill Material ------------ If yes,type -------------- i (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must. be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available-Within 200 feet,) TREATMENT [ ] SEPTIC TANK Pr ��e------ �__---kc3�X IO'---- Liquid Depth --.---r '------------- PACKAGE _I2_- -- G___1Type -- 0WC4WAAAaterial---- ---- No. Compartments ------- Capacity - •-•-=-- Qh' t � r Distance to nearest: Well .__... _ -----------Foundation N__ _--.-_. Prop, Line __.-.,c.............. ._._--Foundation .. __!.. � -- LEACHING LINE No. of Lines PO S-Q_—_-"m'°�"_Total Length ------------------------- J _--- _ -�`�� - ------�-. Length of eac� ling - - - - - g - ---•-------••--••--- Ibt r -- , 'D' Box .. ___.__ Type Filter Material-------------------- th Filter Material -----A `r��--------------••- Distance to nearest: Well ... _---..... Foundation 4�___ V Property Line _..__ ._.-------- SEEPAGE,PIT' f {" Depth __ 2 -------- Diameter ... Nurr��e ------------- Rock Filled Yes 4 No i❑ Water Table Depth -----------1-p .........................=_;_-Rock Size ------Z --------- ---------- s Distance to nearest: Well -------4M--------------------J'_Foundation ./_Q------_---- Prop. Line .... ._ . ._ REPAIR/ADDITION(Prev. Sanitation Permit# --------------------------------a------------'Date ----------------------------------- i e Septic Tank (Specify Requirements) -------- ---------- - --=-----------------------------------------------------------------` ` t 1 { Disposal Field (Specify Requirements) ---------------- ------------`- E � . ..... ............ J7 ----------------- ----'--------..-....-..-------.....------------....------........----------..-----.----------_-------:......-_-.._..._....-----.._.....-----.....-.._-.-.._..-----..._..-.--._...------ i (Draw existing and required add.iion on reverse side) x '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 of1he San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: r "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 bec me subject to Workman's Com ensation laws of'Gdlifornia." Signed- --- ----Z----------------- Owner By - ----- Title -------------- ---- --- (If other than owner) 'FORD ARTMENT USE ONLY ,. ' DATE APPLICATION ACCEPTED BY ------ ------ --- --------------------------------------- --------------- BUILDING PERMIT ISSUED --------: ---- ------------------------------------------- --------------DATE ------------- ----------------------------- ADDITIONAL COMMENTS ------- ------------ -- -- - -- ------- -------------- - - ------ ------------------------------ ---- �- ------ ----------------------- -------- Final Inspection by _z _ _ -----------------�,_at � �� ' ----------- -- ------ __ - Date . .. .- . . ��- '� .w SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M