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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 1Camplete in trri I�cate) Permit No. . --`-�� p . This Permit Expires i Year From bate issued Date Issued Application is hereby made to the'San Joaquin 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: JOB ADDRESS/LOCATION -----'- _✓J-- -.----__�5----- CENSUS TRACT �` 4' ►_ ..---- - _A_, fl ------�/ Name --------- I .(-l?_r'--_ I 1 CH L Phon - - ---- ---------------- Address -------------- -7317------- 5---- = �_ -�1 _. City U Contractor's Name --------Q. f _ _ -------- ------.License # ------------------------ Phone Installation will serve. Residence partment House❑ Commercial :❑Trailei.Court ',❑ Motel ❑Other -------------------------------------------- Number of living units:----- Number of bedrooms _ - _�._____Garbo e Grinder / ._ Lot Size ...________C___ ___ lqG Water Supply: Public System and name _______�'___-______ ----------Private Character of soil to a depth of 3 feet: Sand'L, Silt❑ Clay ❑ Peat J❑/g�{; Sandy Loam ��Iay� Loam Hardpan[] ❑ y ; � F aAdobe Fill Material __- -[?___ If yes, type ______________________ (Plot plan, showing size of lot, location of system in relation to'wells, buil dings,_etc.__musvt_be placed;on reverse side.)� NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT[1" 5EPiIC-TANK'[ ] Size-------------------------------------------- --- Liquid Depth -------------------------- Capacity -------------------- Type ----- -- -------- Material---- ----------------- o. Compartments --------- .:. - t1 # Distance to nearest:'Well ------ - - --------- -------------f Foundation -------- ------------- Prop. Line -----.-------___---•-- D' Box ___ -- -'-'T a Filter Ma egri I -__F # Total Length --------------- LEACHING LINE No;. of Lines -------------------- � YP e a o eac---lin Depth Fitter Ma rial ----------------•---•---------•-•-----•-•-•- ' Distance t n aresttWell .__ Foundation ---- - Property Line ________________•-.-_.., SEEPAGE PIT ) De- th "� - Rb1c yF'ii ed"''�Y [ ) P rQiarneter 7s . "' Number ; ------ --- -- �f s 0"" No.❑ Water Table 'Depth------------------- - - ---- ------ -------•---•-- Rock Size ----------- - - �' Distance to nearest: Weil .______t- - ----------- -------•__-_-_rFoundation _-__ Prop. Line ------..______._. REPAIR/ADDITION(Prb v. Sanitation Permit#--- • --- ---------- ------- --- Dat. ------------------ 1 r P ( pecify Requirements) - I -------------- _ -- '------------------------------ •------. Disposal Field (Specify rpequireme ts) �r��>T_--Ll IN �- �� '' --------------------- ---------------------- ----------- ------------------------;-i ------=---- ---------------------------------------------------------------------------- ` (brow 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 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: < } "1 certify th t 'n th perfo manceUFfhwar which this ermit is issued '1 shall not em to anP p y y person in such manneras to beco ub' ct to ape n laws of California" Signed . . ----- . ) - Owner ti BY -- ----------- ----------------------- --- -----=---------------------------- •�- � - -=----- • Title ---- -----------' ----- - (If other than owner) I } - FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --- ----- ----------------------------------- DATE _73----------- ------------- BUILDING PERMIT ISSUED _ .- t -- ------_DATE ------ ----------------------- ADDITIONAL—COMMENTS- — _- __ ---- ------------------------------- ---------- --------------- �.... _..r =w._. ._ .:_ ---- ------------------------------ -„ - - �- --- ---- ------------ -s - .....�..��-.»,.-.. - .. .. T .r r..L - - -__ r% 7 -•- -�+sTsa Final inspection y. �- ; �-- =�- - --- - - ---•-------------------------------- SAN --- ------------ - ----------SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M