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FOR'OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No: ._'�_.�-.- 'r (Complete in Triplicate) p gate Issued ' '- `-? ----------------------- ----------------------- '` This Permit Expires 1 Year From Date Issue r work rein l the Application is hereby-made to the San Joaquinnr ecwitih Counttyalth trict for a 0 dinars a No. 549 and ex sting Rulesmit to construct and talnd Regulations: described. This applicaion is made'in co p € t, nlCENSUS TRACT _S:767 VN ... .. - -------Ar/j- ---- --------- ------ JOB ADDRESS/LOCATPhone ------------------- = ,AOwner's Name ,- _ _ ---------------------------------- - ---------------- _. city - ----------- Address _. A -- Phone --------------------------•--- Contractor's Name __fIFc CDj.Al.�!-Ds----'O �'�-._ 4' .License # -------- : . Installation will serve:;4 Residence e<Partment House,[] Commercial :[ Trailer Court ,❑ Motel ❑Other-------------- ---------------------------- i, Garbage Grinder/P—/Lot Size Ac P living ------- bgr of bedroorsi___ ------ 9 WatNumer Supply- Publicer of Sy tem and na 'fit f Private -------------- --- - ----------------------------------------------- - Character of soil to a depth of 3 feet-"' Sand' Silt❑ Clay E] ea Pt❑ Sandy Loam [] Clay Loam ❑ _l Fill Material ------------ If yes,type ------ --- --- ------- -- f Hardpan F-1 Adobe❑ +sbuildings, etc. must be placed on reverse side.) {PI'ot.plan, showing size of lot, location of system in relation to wells, NEW INSTALLATION: s`1 {No septic tank or seepa 1 pit permitted if public sewer is available w:ithiif 00 feet,) r SEPTICI�TANIC `a�J Size- ------ ------------------ - -- -------- Liquid Depth ----- -------- --------- PACKAGE TREATMENT.l I I A(Cj' I. p .e _ - ____ ---- 7 Material_ ^No. Compartments --- --�- -Capa0ty » -YP � - t - ,,.-------- Foundation Prop. Line ID.istance--totnearest:.Well _______ __ ___________.-- � , - Len th of each line_7e-----'` =�-- Total Lengthff__- ------ LEACHING LIN'E-• �.No.-of Line•------------ g Q 'D' Box -- Type Filter Matejial _r, 9 C Depth Filter, ____ ----- t`-� I i �_!_ _ Foundation -----��_-''rte_ Property Line �--•--------------• Distance to'r�earest: Wel! _ ----- `! Number - Rock' Filled Yes ❑ No .0 SEEPAGE PIT [ } Depth Diameter Water Table Depth Rock Size -------------------------------- - --- -------Foundation -------------------- Prop. Line Distance to nearest: Well -___________________ � 1 - ------- --- -�--- Date -------------1 l _REPAIR/ADDITION(Prev. Sanitation Permit v ." ._ I Septic Tank (Specify RequiremLntsl - --------------- --------------------------------------- ------ - :.,� _•._ --.:-.__•_: ,- =k g Y q S.......''--- {- # ----------- Disposal Field (Specify Re uirementsl - �. iI ,Ii h ___________________ ____ I -------- ----------------------------------------------------- d`(Drawexisting and required addition on reverse side) I hereby certify that I have preparedthis'appIICdtion and"that'-th work will" be done in accordance with San or County Ordinances, State Laws, and Rules and Regulations of the San Joaquin local Health District. Home owner or liters sed agents signature certifies the following: certify that in efpean��he work For wh'ch this permit is issued, 1 shall not employ any peon in such manner I y as to a me letm n' mpensa ' 1 wst,of California." Owner Signed - - ---------------------------------------- -- Title (If other than owner) FOR DEPARTMENT USE ONLY y pp DATE -- APPLICATION ACCEPTED BY ------ !1 ----- ----- QA.. -------------------------------- BUILDINQ_P_ERMIT 15SUED - - --- --- --- ------ --- ADQITIONAL COMMENTS . .- --------------------------------------------- ------ ------------- -------- ------- ------------ ------------X� - - ______ _.__ .____________________________________ ---- --------_- Date Final Inspectio SAN JOAQUIN LOCAL HEALTH DISTRICT r N 0 1-'68 Rev. 5M