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FOR OFFICE USE: I� APPLICATION FOR SANITATION PERMIT q --- ------------ -------------•------ ---'i- Permit No. (Complete-inTriplicate) -r- .A ------ ---- ------'=----------------------- � Date Issued ___9 _, ,_---_-_--_-_-- _ This Permit Expires ] Year From Date Issued Application Js hereby made to the San Joaquin Local Heal,fh District for a permit to construct and install the work herein described. This application is made in compliance with County O dinance No. 549 and existing Rules and Regulations: CENSUS TRACT ------------ ------------- .-1--- -- ------ ----- - v Owner's NameLOCATION ._- 7. _ Phone _._Q_ - .�qJ!--- --- -------------- --------------------------------- Address .fea__ -lo�� ' Q ----- --•--. City ---`�� . . --- ---------------------------------- 5 3 Contractor's Name __ License # Phone Installation will serve: Residence UV Apartment House❑ Commercial :❑Trailer Court ',❑ Motel ❑Other ------------------------------------------- Number of living units:... ------- Number of bedrooms _�r-----Garbage Grinder ____________ Lot Size -4.1w__ -------- Water Supply I Public SY stem'i�dnd name ------------------------------------ --------------------------------------------------------------- ------Private [ i i p� Character of soil to a depth of-3 feet: Sand Silt E] Clay ❑ Peat ElSandy Loam ❑ Clay Loam El Hardpan ❑ Adobe'❑ Fill Material ------------ If yes, type _____________________----.- (Plot plan, showing size of I, ot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No�yseptic tank or seepage pit permitted if public sewer is available within 200 feet,) ' PACKAGE TREATMENT [ SSEPTIC TANKX] 1 -' Size___ ___y-_ll__�___�I__a�__----- Liquid Depth ------- +�j--• . Pl Y Type � - Material__S�+ugjt.cv No. Com artments ------- Capacity dy ' Ca aat Jrof� T e P •: Distance to nearest: Weif _____= �_ - --_---------Foundation --- Prop. Line _-�L -- ---- Total Length LEACHING LIN 4(J No. of Lines ------ -_ engih of each fle____/_ �______ `-• '�* D" Box ____r____._ Ty"pe Filtef�Material ------«Z----------Depth Filter Material ____________ __ ------------------------- IL-' _ _______!_:____---- ..�(.�.:fir. .ip F pry; ___ - _ l ._-- ____--_ 9 Distance=to-nEarest:_W_ell_______ �. Faundafiion_.._-_,___ Property Lute. _____ __------_....... p - ---- - Diameter Numbe, �� -------- ❑ { ( � - - � ----- ------------->-____---Rock Size __.�_ -------Rock Filled Yes No SEEPAGE PIT �[_] w De th, _ _ -- _ --- ❑ Water Table Depth -------------------- ..Dlistance to nearest: Well ----------------------------------------Foundation 'i------------------- Prop. Line ---------------------- F REPAIR/ADDIT[ON'{Prev. Sanitation Permit# ------------------------ _ Date _-__-_______I_._________________.) ii , % I Septic Tank (Specify Requirements) ----------------- -----------------------------.. r Disposal Field {Specify Requirements) -----------/,06 ga. . _r� __ Mtn-s-- ------------------------------------------ ' ,FFJ1 a ----- -- --------------------�--- ------- ----------�1,6--------- 1 ----------------------- ---------------------------------- -------- --2------------------------------------- --------------------------- --------------------------------------------------------- --------- F (Draw existing and required addition on reverse sidel I hereby certify`that I have l�prepared�this this and that the work will be done in accordance with San Joaquin 4 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 as to'become subject to Workman's Compensation laws of California." • r Signed Owner - ------------------- Title ------ --------------------------- By If other than owner) FOR DEPARTMENT USE ONLY ' ACCEPTED BY -- = �� "----------------------- ------------------------. DATE ------ APPLICATION BUILDINGPERMIT ISSUED ------------------------------------------- ---------------------------------------------=--------------DATE ------------------------------------------- ADDITIONAL COMMENTS �' -------------:--------------------=----------------- ------ �. ik '------------I-------------------------------- --------------- _________._ 14 -1 - __ __ __ _ __________ _ _ _-------------- ----------------------------------- FEnal Inspection by. Date "'' �'��---------- SAN JOAQUIN LOCAL HEALTH DISTRICT ' E. H. 9 1-'68 Rev. 5M