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FOR OFIrICE USE: „r;•k, ' APPLICATION FOR SANITATION PERMIT ------------------------------------ Permit No. -1�' � (Complete in Triplicate) ----- = ---------------------------------------- - �� ---------------------------------_._______.______--___._ This Permit Expires 1 Year From Date Issued Date Issued PP Y � qui��f�t� for� . Application is hereby made to a San Joa uin Local ealth Dis pct 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: JOB ADDRESS/LOCATION ---- __tSW) frZ) --- --- ...... _ �/,E�- ---NjT - ,---CENSUS TRACT ----- -------------------- -------------------Name F��}d.�__-� _ _ Gf _T ,� '„” - ': -----Phone�.�..�'.'-�1r � �<F �---------------------= Cit - ----- Address -- - -�- .- - -----� -- - - � '. -•--� Y�R��n1------------------------------------------------- Contractor's -- ------------------------------A----Contractor's Name - J / '_ .� �----ZF1t`r�--___.---._:-w=__.License PhoneeP��=_��F Installation will serve. Residence 9�<Partment House,❑.,C-ofnmercial:❑Trailer Cou_rt'❑ f Motel ❑ Other ____ �( _; a Number of living units:--- ------_ Number of bedrooms g .j - -CS-. 6--_-__-- G 1 - -_-_---Garbo e Grinder__- �.ot•,Size _.______.� __ � Water Supply: Public System and name ----------------------. -------i---------------------------------------------j " —' Private ®� Character of soil to a depth of 3 feet: Sand' /silt❑ Clay',❑ Peat❑ Sandy'Loam •❑ Clay%,L6am "❑ tj w Hardpan Adobe f 7---------------- (Plot -- --- � � P ❑ ❑ _FiINNlaterial --- If yes, tYP�----------- ---------- -- t (Plot plan, showing-size of lot, location of system in relation to wells, buildings, .etc.,must be pldced-o`n reverse side.) ' NEW INSTALLATION':"' (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) ' PACKAGE TREATMENT [ I- SEPTIC TANKiVT' Size _ = ' /___.'_ -------=---- Liquid Depth _____ I Capacity --- .j ------- Type�Z� - _ Material .ETE ,No: Compartments -2-:----`--:_--- t Distance to nearest: Well - ---------------------------Foun tion _jO.--_--------__ Prop. Line__.;________ LEACHING LINE [,f' No. of Lines -,,-2— Length of; each line � ._.__�__,Total Length ---------P....__:__._.__ i N r .i ' 'D' Box .-V��- Type Filter Material X49<4--------Depth Filter Material Z?_ . _________________________ i Distance to nearest: Well -___ Q_____--__.:-____ Foundation - %-=-{ Property Line _____........ ....... F SEEPAGE PIT [ ] Depth ---------------- -t ©iometer ----------- Number ------------------- ---------------------------- -----------__-_ -- Rock Filled Yes ❑ No Water Table Depth 1 , _. ._--.-__�_..--.= Rock•Size•M �'-r `` Distance to nearest: Well -----------------------------------------Foundation----- -------- Prop. Eine -__---_-__._----.-__-_ REPAIR/ADDITION(Prev. Sanitation Permit# --------------------------------- --------------'_-------------_ _ ---------:-.- - ----------- Date -- ------------------ ) --_ (----------------- ' Septic Tank (Specify Requirements)---------------------.-----=-----------=--�-------------------------------------•------------------------- -. ---•-- Disposal Field [Specify Requirements) -------_ _-- ;.------------------------ -------------- --`. _--__--____- __-_.--_-_---�------_--____.- ....r.._..+.-f..f _ ------------------------- --------------------------------------------- ---" _ ------------.--------------------------------------------------_---------------------------------------------'-•----------------_----.-_ Asti --------------------------------------------- '---- ---__--- _.-_-_-__----_--------_------ ----------------------- ---_--_______- ::;------------------------------..------_- c-`_____-___.___--------_ x [Draw exisfiing 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. 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." Signed -- --------------------------- -------------- ----- ----------------------- - - Owner BY -�- ---------------------------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --------- -------------------------------------------------------------- DATE ------------------- - -_-- BUiLDING PERMIT ISSUED ------------ ------------------------------------- - ------------------------- -------------------------DATE ------------------------------------------- -- ADDITIONAL COMMENTS -' r - -- --------------------------------------r- --- - - -- — — Final nspe b f /, f Date ---- -------- --- - SAN JOAQUIN LOCAL HEALTH DISTRICT . .....E. H. 9 1-'68 Rev. 5M