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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -1-7—/SL/ Permit No. ..................... ......................._...................... (Complete in Triplicate) : ..................... Date Issued ...................... ....... �.`��:.... ............................. ................. This Permit Expires 1 Year From Date[slue l the work herein Application is hereby made to the San.-Joaquin wial th Couealth Dy, O diva a istrict. for a No. 544 and existing Rules rmit to construct and tand Regulations. described. This application isymade in-compliance, f ...... ............... .- ..... 1 _... ; Cl:Nsus TRACE JOB ADDRESS/LOCATION .: �.......... . _ ........................ r_ Owner's Name ... 4-... ��j= �. .............. City r`-�"- F' Address ._.._.... _ ..�-xf 7`T... � _ _ Phone Contractor's Name -._.. _..:_ ._. G' - License # , ��-- F i Installation will serve: Residence U�Apartment House[] Commercial ❑Trailer Court Motel El Other ............................... oms ....$k..Garbage Grinder ...._---_.._ tot Size ......._.•..-------- ............. Number of living.unfits:.____..._ Number of bedro Water Supply: Public System and name ...------•-•--------•-•--------•....---------------------------- -•----...--•-...... ,-•---- ..,-Private❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay C] Peat❑ Sandy Loam U Cloy Loam 0 y e ------------------ --------- Hardpan ❑ Adobe ❑ Fill Material ............ 1f es,type (Plot plan, showing size o'f lot, location.of..system in relation to wells, buildings, etc.,r6ust be placed-on reverse side.) NEW INSTALLATION: JNo septic tank.,or seepage.pit.-permitted if public. sewer is available within 200 feet,] - Liquid Depth S Size.. :�=••••-. . q p PACKAGE TREATMENT ( ] SEPTIC TANK ] ¢" : Material.... .. No. Compartments •• Capacity IV-011...,Type „ ... �' fine '~ ..Foundation _-- - ..:.:._._ Prop. L ••-........ Distance to nearest: Well ____:..._.___.. �--•----- ' LEACHING LINE ( 3 No. of Lines .--- ......-•--••--- Length of each line.---.,/ �.............. Total Length 'D' box Type Filter~Materlal "_....... =-•• epth r_Material -- -- Filt . . w�. ,�. - ndation _... --------------- Property Liner: ..... _ Distance to nearest: Well .....::...... .. .,g R Rock Filled-.,,Yes,, -Q Diameter _... Number .1•.---.----- Water Table Depth ................ .........Rock Size ...... ... ••••-.. . w. .' _....� —.o-• I r e .......................... ,-- }x. Distance to nearest: Well ....Foundation .._.. pop. Lin --�--------... Date ••-••----•.....� REPAIR/ADDITION(Prev. Sanitation Permit .------•---••-•- - �•- � - a �. ................................................. Septic Tank (Specify Requirements) ---•---... .....-•--•---•---•-••-----•----•-----••- Disposal Field-(Specify�.Requirements) ---------------- -------•-•-•----------------••------------ -------•--•--•--- .....................•----...-----•-------...._... _.._....._ _ .. A.y` __._____.•-------------------••-------....---------...----------- - 4.:-s Y A: �1 K \F . y � w ..,,,..caws • .. i+ .i 'x _ _ _________________ __________________________________________ _.__.____.__...__..._.....___.___....-...._...__._..__...._._____..._...__.....___.__.. (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 San Joaquin County Ordinances, State laws, and Rules and Regulations of the San Joaquin local Health District. Horne owner or licen- sed agents signature certifies the following:. arson in such manner "I certify that in the performance of the work for which this permit is issued, l shall not employ any p as to become subject to Workman's Compensation laws of California." i Signed -...._..__ Owner _ ----- -•......... Title ............................................ By l(if other than owners FOR DEPARTMENT USE ONLY _ . SLA . .,y .......................... .....• DATE ----- .' :/. ....... APPLICATION ACCEPTED by _.... .t. - Aa—. -••••-•. . ..DATE _.._...:-------------•-.-••................. BUILDING PERMIT ISSUED ..... ---•------- ---------- ................................ ADDITIONAL COMMENTS -._. .. __ __ --------------- - y _ .................:._---------._...-•--•-• Date .. , •• /.... ... Final Ins ection b SAN J AQUIN LOCAL HEALTH DISTRICT 7/72 3 X