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{ FOR OFFICE USE: f .. APPLICATION FOR SANITATION PERMIT iM ----------------- ` (Complete in Triplicate) Permit No. � ----------------------------------------------------- --- - I-_-_ This Permit Expires ] 'Year From Date Issued 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:is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: - �_I-VF - ----CENSUS TRACT --.S--S -------- JOB ADDRESS/LOCATION ZQ�I- J ____- ------ -- Owner's Name ----------- 13g_R} --------- --------------------------------------Phone-----------------------------------__ Address ----------- Q-(0��'�" --c---:- f3-.1 V-E�--------�D----------------•--. City - ---R-t-i a-N------------------- --------------------------------- Contractor s Name _0W_A[!-i F--- ------p -----------�---------.-.License # ---------.---------'�- Phone ------------------------------ Installation will serve: Residence artment House Commercial ❑Trailer Court Motel ❑ Other -------------------------------------------- nn // Number of living units:_.--1---' Number of bedrooms _---Garbage Grinder Ak---- Lot Size ._J9C9 �'�_--_.--___--- Water Supply: Public Syst- --and'ncime --- ------•---------•------------------------------------------------------------------ -------------- Private —_Character of soil to --depth' f-31eet:'�Sdnd'❑�Silt❑ 'Clay "E ' --Peat❑- `Sandy Loam- Clciy Loam'❑ -°` "''"' "� �._. 4 Hardpan E] Adobe-E] Fill Material lV--{�-_. if yes, type ---'—------------------ (Plot -------------- --(Plot .plan, showing size olf lot, location f 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 i eavai able within 200 feet,) Q PACKAGE TREATMENT I ]� SEPTIC TAN f ] Size----------'-------------------I---.--- ------- Liquid Depth .-------------------_ Capacity ------------- - Type -------------------- Material-------------.`-------- No. Compartments ------ ............... Distance to nearest. Well __ ---_---------------------------Foundation -._ ._ -_____________ Prop. Line .._.____________..._.. LEACHING LINE [ ] No. of Lines ------------------------ Length of each line--------------------- ----- Total Length .---_-------;_----.._--..--_. ten,„ i F 'D'I� Box --- -------- pe Filter Material ----------Depth Filter Aciterial -----------------------------------------•-- Distance to neare t: Welhs...--------------------_--'Foundation --------_-_-- -------- Property Line. ---_----.---..._-_.-.._- SEEPAGE PIT [ ] Deipth -.----.--.--_--- _ Diameter ----------------- Number• .-----_-------.-_ -------- Rock Filled Yes C] No C, Water Table De `_---- '------ ___-•--Rock Size __-'- ------------------------- ----------------------- Dis�ance to neares ell --------------------- I III '- ,n . -- -----v---- , n.�te, ation - ---------------- )P rop. Line ---------------- REPAIR/ADDITION(Prev. Sanitation Permit r----- Datea 5e tic Tank {S ecif Re �irements).------------------- -'- ------ - ------------------------- ----------•------------------------- -• -------------- Disposal •-_--_----•- i ' Field (Specify 'Requirements) ....-._TL6H_T---.--I-I'VE.------F--Rom--------a X�-��7�/�G----&C-TlVE- r--62�------- `= X'/0 X- ---------------- ------------------------------ ----------------------- -- ------- --- -------- I (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be done in accordance with Son Joaquin County Ordinances, State Laws, and Rules and Regulations of the San JoaquinAocal Health District. Home owner or licen- sed agents signature certifies the following: "I certif t in the enformance of the work for which-this permit is issued, I shall not employ any person in such manner as to co subjec o W rr an' Co pensation laws of California." y e+rr ---------------- Y -------------------------------------- ---------------------� Title er ,' (If other than owner) 1 FOR DEPARTMENT USE ONLY Y_ APPLICATION ACCEPTED BY --- --------------------------------------------------------------------- DATE __._57 3 -7Z-__----- BUILDING PERMIT ISSUEDi-- ---------- DATE -------------•- --------'----------------.. ADDITIONCO AL MMENTS - -- ----- -----------------------------_ _--.. ___ ------ ------------ ___- --+---------- --------------------------- --- ------ T f. ----------------------------------- t,--==•_=__=y = - - ----------------------------------------- -------------------------------- I Finallnspection Y ---------------------------------------.Date --------- [ _SAN JOAQUIN LOCAL HEALTH DISTRICT k E. H. 9 1-'68 Rev. 5M,