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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ------ _ .. Permit-No-V':_�,�_v_ m ------ (Coplete in Triplicate)' — __________________________--__-___________-____-__ r-` This Permit Expires 1.Year From Date Issued Date Application is hereby made to the San oaquin 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: ' CENSUS TRACT ______;_ JOB ADDRESS/LOCATION . fJ Q � (' ` 5 = - -_-- `'S� 6� Owner's Name --------- Li-------- ---------------` -----Phone z. Address ------ ---------- (00V 0LIr • Cit ------------------------� -- r Ys' I, l Contractor's Name -------� , - ------------------------------------------------'-------- ----- ----- Phone ------------------._.--------- _ r� License # ------- ----------- Installation will serve: ResrdeAce ❑ Apartment Nouse Commercial❑Trai.ler Court �,❑ Motel ther ------------------ Water Number Supply: Public'System and name of bedr oms __�_____..YG�a�rbagne Grj�der j--.--------Lot Size---• _ ____________ _ _____________________ living / - ----Private ❑ Character of soil to a depth of 3 feet: Sand' Silt -- Clay-E]- - Peau❑ Sandy i oam ❑ Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material ------------ If yes, type------------------------------ (Plot -___-____._°_______________(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., must be placed on reverse side.) }n NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,► PACKAGE TREATMENT [ f��EPTIC TANK' l AV: Size __YX S l®/ y - Liquid Depth Capacity Jed____-__ Type p"G�''�_ Material_4vNo. Compartrobnts __ ,r______________ Distance to nearest: Well __ ------------ ----------------- Foundation __�d _-__-___ Prop.Line ___`r _________ i /;)LEACHING LINE �Q No. of Lines ___.___j______________ Length of each line-_.___/�t�____._____ Total_ Length` i l!!`` r t 'D' Box _/CEO... Type Filter Aaterial46044-u-Depth Filter Material ------1,4:!� Distance to nearest: Well _. ________________ Foundation lUU------------------ Property Line .......... SEEPAGE PIT [ Depth ____________________ Diameter ___-__-_______-_ Number ______._.__________________ Rock Filled Yes ❑ No 0 F j Water Table Depth --------------- -- -- ---------------Rqck Size- T------------------------- l i � Distance to earest: Well ----------------------------------------Foundation _________________ Prop. Line ........__.. ......... REPAIR/ADDITION(Prev. Sanitation!Permit# -------•------------------------------------ Date ---------------------------------- F. Septic Tank (Specify Requirements) A ' -,.. DisposalField (Specify RequireTnents) -------------- --- --•--••--••----------------------------------------------------------------------------------------------------- I i l �. (Draw existing nd 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. Home owner or licen- sed agents signature certifies the following: f "I certify that in the FerFormanj6 of the work for which this permit is issued, 1 shall not employ any person in such manner as to become sub' toW a ensation' of California." Signed ___--_ Owner — BY --------------- --------------------- Title - ---- -------------------------------------`` (if other than owner) i 43 00 F PARTMENT USE ONLY APPLICATION ACCEPTED BY -------- _bATE ----- _��9'T� BUILDING PERMIT ISSUED ----- _ - _ ATE -------- AL'DITIONAL COMMENTS .____ t�.e__-__-- _- 24 ��`- °`� ��O '- fi' P --- ------------------------------------------------------ -� 1:_: f ------------------- $ z '�- = ------------------------------------ ----------- FinalInspection by: ------------------------ --------------Date _= -------------------------- ll SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M