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FOR OFFICE USE: 'k. APPLICATION FOR SANITATION PERMIT "' ,omplete in Triplicate) ' - Permit No.. i � 1 ---------- ------ M1 '` This Permit ices 1_Year Frorn.D to Issued Date Issued -- ---------------------_ ._._----- ---- — _ _ _.._.+. _.. __ a.t.� ��.,_..�. -- Application s hereby made to�the,San Joaquin Local Health District for a per to construct and install the work herein described. *s a p]icatiori is ma' ' rc'o nce with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOC=ATION ------ - :- N , ___--- F ---CENSUS TRACT _:�:/- -`-------- -- _ -3-3-i re 11'-1 `A hone ' Owner's Name _.. _ t t� "City' = , i ) r µ Address ----- ' -- - --- = 3 -+ l i f _. Contractor's Name ` -----_License # Phone Installation vlril I serve: Reside ce �8rtment Nouse-❑ Commercial []Trailer Court ;❑ i ,� " ------ , � �. ! Motel ❑Other ----------------- ------------------ Number of living.units:_.___ _ _._ NumberI oi�edrooms ________Garbage Grinder __._ ___ Lot Size __ i Water Supply: Publit;System and name ��,� ------: _t; ,.��------ _------ � .y.�-y~Private E] Character of soil�to a depth of-3 feet: Sand'[, Silt(] Clay ❑ Peat❑ Sandy Q Clay Loam ❑ ; Hardpan ❑.- Adobe.❑ Fill_Material �__--- If yes,type -- -- -------- ------ r, - -- _ .- (Plot plan, showing size of--fot,,.location of system "in-'6tion to wells, buildings, etc, must be placed on reverse side.) NEW INSTALLATION: (No—septic tank`or seepage pit permitted if public sewer is ay „able within 200 feet,) V �� 404 PACKAGE TREATMENT SEPTIC TANKL Size__.____ - -� Liquid Depth -- --------- 6 I 7 [ t �; Capaciti-Type & ;� _ Material--- ,� Com artments -------y � i p.istance to nearest: Well ----45-0--- --------------Foundation----- -- -- -_ Prop. Line ---___-- ------ LEACHING ( No. of;Lines� __________________ Length of each line-- s--11�---I -11 Total Length -�'3_...__-____----------- .. Len 1/\ zD' Box ---1; Type Filter Material _ti .-------.Depth Filter Material --- i �----•-----� } v Distance;to nearest: Well .___/__�. (___ Foundation _.__.___I -----_-__- Property Line --_._-.=.____-__-..-.__ SEEPAGE PIT [ ] x.-,Depth :�--__�..___._------------ Diameter ________________ Number ._____--.-_-.-__________-- Rock Filled *Yes ❑ No ❑� i pWater+TabliafDepth ------------------------------------------------Rock Size -------------------------------- f1 .a f ,_ Founder ation Pro Line ._ ' , Distance to nearest: Well ----_---____ p REPAIR/ADDITION(Prev'Sanitation Permit# --------.-•--------------------------------- Date --------------- _� } �+ SepticTan{k (Specify Regjirements) --------------------------------------------- ---------------------- -------------------------------------- �. --------------------- Disposal Field (Specify, Requirements) ------------------------------------------:-----------------------_----j------------------------------,'------------------------------- � i fv . :Ic w , 9- a 4t r __- ,. (Draw existing 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 Sate Joaquin County Ordinances, State Laws, and[_Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- i 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 3 as to become subject to Workman's Compensation laws of California." Signed ------------------------------------- ---------------------= ------- Owner : >( '•'! t -------------------------------------------- - ------------------------ B Y ----------- ------ ---------------------------------- T=�----C=� t = -----------? - -Title ` If other than owner) ,,,�,° _ r 4 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --------Fj --- 1-0-.!-------- !----------------------F--------------------------------- -- DAT E ----- ------ BUILDING PERMIT ISSUED ------------ �� --------------DATE --------------------�----------7------�-------.- ADDITIONAL COMME_NT_S. - r - - - - ------------------------------------------------------ --_-------- ---------- ------ - _ j -- ------------------••------------------------ --- -----• / _ _____ ---------------------------------------_ _ ._____-. --------- _._____ _ -__s# Dat Final Inspection Y: �-- - �. '� e SAN JOAQUIN LOCAL HEALTH DISTRICT..... �- ! E. H. 9 1'='68 Rev. 5M T