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FOR OFFr,_E USE" APPLICATION FOR SANITATION PERMIT �'�� Permit No _"� .--- - -=a`V IComplete in Triplicate)._0-_7 ------ ------------ ------ ------------------------- /I Date Issued -r 1 ------------ ------------ ------ ----------- This Permit expires 1 Year From Date Issued j - 1 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application Ni made in compliance with County Ordinance No. 544 and existing Rules and Regulations: > -- ._ `CENSUS TRACT ---- -- - ---- JOB ADDR>=S5/LOCATION .��=`�-�' S----S�'--- _i��__ ,rr...................1� y ----� - Owner's Names [� p V L.I Jld [ 7`rte rV ---------- -- --- Phone - - - - ------ N ----- - rt { r C Address .......... �� l -- --- ------ � ---- Phone ----••-------- C�AKD.I9_�--- - ------ ---------------- Contractor's Name _ .___ _ � _�_____________ _-__.License #---�,�;---,---- Installation will serve. Residence ❑ Apartment House Commercial❑Trailer-Gewft Motel ❑Otherl- f �<_ �I�Ar _E------ Number of living units------ Number ofe,loedrooms -_ _______.Garbage Grinder.__ Lot Size __ __ _____ _ _ __ Water Supply: Public System and name.---____------------------ ----------------------------- -------Private ®� Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam [Clay Loam ❑ p r' i -------- f' Hardpan Adobe ❑ Fill Materia! __ _ __ ___ If yes, type ___________________ i i (Plot pldn, 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 seeps pit permitted 'if ublic sewer is available within 200 feet,]/� SEPTICTANK; `Size_--- _�Q - ----------- Liquid Depth _�_91--------- ----------------------- TREATMENT { ] [ / Capacityjj�-Q=Q e`�? cs�aterial-- � No. Compartments -_z— -- --- is'tance to mearest: Well_ - ------------Foundation ----/0!7�--- Prop. Line __.. _ ____ Total Length :__7=��---------• � LEACHING LINE No. of-Lines.._4�r------- Length of each line_-� ---------- g �jS! :1 A �j x I D' `Boz _ _ T e Filter Material _[ 1_�1.C1<-Depth Filter Material ----------'------------= ; Yp J f�=s��----- Property Lind Distance to nearest: Well __/_D ____-______ Foundation -_--- t ; t //// Rockfilled, Yes �N . ' � _ Drs efer:i i.t_��i1__rNumi�er-_---_�_-_-_�� .. SEEPAGE PIT Depth �_.___-._.___-- +� �Mr _--� ------------Rock Size r Water Table Depth -- ----��--�------"+^- - . --�-'---- '� _-�-- fi_-----•---Foundation -----1� ------- Prop. Line ---- --- -- Distance to nearest: Well _.______�� ------- - I REPAIR/ADD_('TION(Prev. Sanitation Permit# -------- ----------------------------------- Date ---------------------------------- Ii ----------------------•-•--------------------------- Septic Tank (Specify Requirements) -----------------------------------------V�c -------- Disposal-' Field (Specify Requirements) --------------------------�-•--- •----------- -�------------ ------------------------- ------------------------------•----•----- ------------------------------------------------------------ ---------- I -- -------- ---- ---- ----- ---- -�. —. = --------------------------------------------------------------------------------- --- f (Draw existing and required addition on reverse side( 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County Ordinance's, 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 t tiperfor ante o the work for which thi permit is issued, I shall not employ any person in such manner as to becc kman'7 m ensatio ws of alifornia." F Signed L o r_(A__0-- ....• Title ------- ------------ ((If-other than owner) .-FOR DEPARTMENT USE-ONLY-- e- - - --- / - APPLICATION ACCEPTED BY R" •1 L= = �`_\ � DATE ----- -- 7,1 _- 7 2 . i BUILDING- PERMIT.ISSUED--------- - -------------------- :-=DATE_== - :_- ::::�_•= w �::. ADDITIONAL COMMENTS = - -- -------------------------------------------------------------------------------------- ------------------------ - ------ ---- --- ------------- ----- ----- ---------------------- - ----------- - -------------------------- - -------------------------------- --- ------- ----- - -- ---- ---- - ----- ------ -----------------------Da-a------ Final n SAN JOAQUIN LOCAL HEALTH DISTRICT F H 0 1.'68 Rev. 5M'