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FOR OFFICE USE: f + APPLICATION FOR SANITATION PERMIT 7�-. ------------------ (Completejin Triplicate) Permit No: ------------- --------------- This PermitlExpires I Year From-Datelssued I Date Issued I k Application`is hereby made to the San Joaquin Local HealKDistrict fora per.mitito c nstruct and install the work herein described. This application is made#in compliance with County Ordinance No. 549 and existing Rules and Regulations. 11} l� � , JOB ADDRESS/LOCATION ----------------I----------------CENSUS TRACT ----------------_.__------ t Owner's Name --- '�,. Phone �,��- -- -------------------------- Z _ Address -------�/G 1.1_---- -- --rl �,� City t ti--� 1� ----------- ---------- ------------------------------------------- ------ Contractor's Name f -- � License #f Phone ^ 607.. Installation will serve: Re sidence�Aplartment House❑ Commercial :❑Trailer Court ❑ / Motel ❑Other ------� --------------- / y Number of living units:_.-_[_____. Number ojbedrooms _-_�_.__Ga cge Grinder ------------ Lot Size ---_-0)(1-`� _____________ f , t d—i Water Supply: Publfc,System and name -------------- ----------------•-•----------------------------------------------------- -I-------------..------Private ❑ Character of soil to a depth of 3 feet Sand.❑ Silt❑ Clay ❑ Peat❑ Sandy Loam E] Clay Loam:F Hardpan❑ Adobe ❑ I Fill Material 777f yes, type i_-________._______________ (Plot plan, showing'115 ize.of—lot-cation4of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: fNtank.or seepage-pit permitted if publicsewer is available within 200 feet,} r. �Siie---____ -jPACKAGE TREATMENT SEPTIC—TANK � ._r;_ !�. n______ ___ ----____ if iquid Depth ----------------__________ Capacity ----------- l)' -------- Type ----�----}__-- Materia -_ _-- No. Compartments ...................... Distance to nearest: W611-1.--------\------ --- --.Foundation_---------------------- Prop. Line -___-________________ 1 LEACHING LINE [i j No, of Lines _- Length of e like+.,_._ 1_�r+_ Total Length __________________________•_ D Box ------------ Type Filter,Material =-------------------Depth Fitter Material -------------------------- ....... -_-_----•- (f1 Distance to nearest`Well --_---.-___________\Foundation _______----�---- ----- Property Line_____________________J_1 p Depth _______________ ____ Diameter -- i SEEPAGE PIT 1.]J-701 ---------------Number ----------- ---------- Rock Filled Yes ❑ No C Water. Table Depth -----------------------I-------_------ ti•.Rock Size ---- ------------ -----•--... Distance to nearest: Well ______________ ._...Foundation ------------ ...... Prop. Line _______--:•_--•-•-..•- REPAIR/ADDITION(Prev. Sanitation Permit# _I._______________ Date ___-__ ._ ---- ------------- --- 1 0 Septic Tank (Specify Requirements) ._- - ------- ----------------------------- . I I Disposal Field (specify Requirements) 'fif - i = -----------------------•--- ------ F -------------------le------`f ; 1__0- ------- ------------------------ ------------------- ----------------------- ------------------------------ ------------------------- I � ; {Draw existing and required addition on reverse side) l I hereby certify that I have prepared this application andthatthe work will be done in accordance with San 'Joaquin 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 j as to become subject to Workman's Compensation laws of`California." Signed --------------- -------------- ~V Owner ------ ---------- - ------------------------- BYn,.Q--- Title --------- - t (If of er a owner} ! l FOR DEPARTMENT USE ON)Y APPLICATION ACCEPTE BY / t --------- -------------- ---------------------!------. DATE BUILDING PERMIT'ISSUED -------°------------------ ------ --DATE ------------------- AL COMMENTS ------------------------------------>-a---------------�--------------------------------------------- --------------------------------------. t - ------j---------------------- ------------------------------------- --------- - ---- ---------- �.� .� --------------------------------------- --- ----------- ------- --- - - ---=- -- -------- - -------------- Inspection b =-- - _ f ------------------------------- Final - P Y Dat . SAN JOAQUIN LO AL HEALTH DISTRICT E. H. 9,. 1-'68 Rev. 5M