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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT /--�------ F Pe -- rmit No. (Complete in Triplicate) ---------= -----------=------------------------ ff Date Issued -�1-----`. --- -------I__ This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application As made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION 'p - l 7 � %; -----CENSl�15 TRACT ,� Phone -�� Jf Owner's Name 1 ._ ---- City l Address ---- _ --- -------- � Contractor's Name N ------ � -----------------License #`-60.L_I�-----1 Phone W A--_- ---- 7 Installation will serve: I Residence [KApartment Housei❑ Commercial,❑Trailer Court ❑ Motel 0 Other ----------------- r w� I ____ Number of bedrooms`_ '� age G 'na ir ---._.,----- Lot Size ---(06- f � Number of living units:----- ',-"-- Garb V'"-41 Water Supply: Public System and name ------- -------------------= --- -------- Private ❑ Character of soil to a depth'!of 3 feet: Sand C Silt❑ Cay .❑ Peat ❑ Sandy Loam ❑ Clay Loam.tel Hardpan❑ Adobe'*`Fill Material%Tt , If yes, type ------I.-.----------------_--- � (Plot plan, sh wing size f lot, location of"system in relation to wells, Jildingsr etc. must be placed on reverse side.) NEW INSTALLATION: (NSM septic dnk or seepage pit�p r 1 ed if public ewer is available within 200 feet,} x, tib L' ) _x< it srw. ,a x t t PACKAGE TRI=ATMENT E ] SEPTICtiTANK;['] Size------- ------ - Liquid Depth ---------------------.-- -- CaI ---- Material----- ------ --- No. Compartments -----------.....- pacity _..- �TYPe�--------•----- - - -- ` P �f� �`► Distance to nearest: Well " -!'- "-I--------------------Foundation ------------------`--- Prop Li a ----.---------•------- L ] t e-ngth iof each line----- ------------_------ Total' Length ------------ -------------•-- LEACHING LINE �No:f"Lines"'"'"'-.- - t---� L 'D'`` Box ----------.- Type Filter Materidl9 ---------------- _ Depth Filter Material -----------------------.----------------- N 1 1---- -_ _ -------------------- Property Line. _------ --------------Distance to nearest: Well ------- Foundation SEEPAGE PIT i ] Depth -------------------- Diameter ---------- Number ---------------------------- hock Filled Yes ❑ No 0 Water Table Depth `� --- �...��--=_-__.___ Rock-Siie - ------------------------ 1M I . IM I -- ------Foundaon ------------ -- h Distance to nearest: Well ------------ ----------- -- Pro Line -----------------•---- 1I Septic Tank (Specify. Re u�remenYs}. �' = Date = REPAIR/ADDITION K ) REPAIO pp Sql�natation Permit# - t Disposal Field (Specify Requirements) ----- - --- - - ------- ------- ---------------------------------------------------------------- ---- H x _---- . - - = � r ----- ---------------------- --- -------------:---------------------------- -'----- - - ---- -- ie - Dww. .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. SunJoaquin-e cal Health District. Home owner or licen- sed agents signature certifies the following: V !1 "I certify that in the perFo�mance of the work for which this permit is issued, I shall not employ any person in such manner as to I� l Signed become subject to Workman's Compensation laws of California."Owners � 1 BY -- _- CitEe - --------- ---------- (If of er th ner) I FOR DEPARTMENT USE ONLY �� DATE-----1 5�� ------------------- APPLICATIONACCEPTED I BY --- ------ ---- - - ------------------------------- ------------------------- f. BUILDING PERMIT ISSUED ---- ---_ DATE----------------------------- ------------------------------------------------------------------------------------------- ADDITIONALCOMMENTSG --------------------------------------------------------- ---------------------------I -------------------=-------------------------•---------------- ---- ------------------------ ----------- k -------- I — — ------------------ ---- ---- -- 7- -------------------------- -------- ---- Final Inspection by.—.--- . Date \- _._ -- _ -- ------ --- -_ SAJOAQUN LOCAL 'HEALTH DISTRICT - E. H. 9 1-'68 Rev. 5M