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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT �0 r `' ` . Permit No. ___________________ (Complete in Triplicate) 1-13-7b __________________________ This Permit Expires 1 Year From Date Issued Date Issued _-_ _ _ _ . Application is hereby made to the San Joay I istr' t 1or7c per it to" lconstruct and install the work herein e described. This application is made in co rTi I' C unty Ordinance N 544 nd existi Rules and Regulations: _1 IS --- - CJOB ADDRESS/LOCATI Owner's Name ?] ------ -- -------- --------- ------- - --------- -P .one -- -------------••---•--••---•---- Address - ---------------- -- - ---- ---- -- L G�' ��y city C, � - Contractor's Name --- - - --- ----- --------- ----------------------------------.License #/+�- ------- ---- Installation will serve: Residence [] Apartment House ❑ Commercial OTraller Court ',❑ Motel ❑Other ------------- ---=----------------- i Number of living units:___--.1.__ Number of bedrooms _______Garbage Grinder Lot Size ------ _._ __-________ Water Supply: Public System and name ------------------------------------- ------------ ----------- ----------------------------------------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Cla E] Peat E] Sandy Loam E] Clay Loam Hardpan ❑ Adobe Fill Material if yes,type ---------___________________ a - t {Plot plan, showing size of lot, location of system in elation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,► PACKAGE TREATMENT SEPTIC TANK Size_ f r { 7 -�-��-�- - �-- � - Liquid Depth :� -----------------• Capacity/;?--;;A"/Type Type __ Material_. _'_._ No. Compartments - -____l Distance to nearest: Well ____-_Al`_��___--------------Foundation _-`(�_------------ Prop. Line -- t0__ __._..-_ s � LEACHING LINE No. of Lines _._--�--------------- Length of each -liine.._/��_ Total Length - ______________.- 'D' Box 1_Q<�__ Type Filter Material _� Ql�-_Depth Filter Material ley______________________•_-_-.-._. ► ------------ ------ - F Distance to nearest: Well ---�__----------- Foundation _._�_�_____________ Property Line _____ ________._._ SEEPAGE PIT Depth 10tr-_-__ Diameter ta -_.--.- Numbe ..._2----------------___ Rock Filled Yes� Noi ❑ `r 41 Water Table Depth _d---_____________-----------------Rock Size Distance to nearest: Well ___/'ill-------------------------Foundation ---------- Prop. Line _I/ ----------- REPAIR/ADDITION(Prev. Sanitation Permit# _-_____________________2�!�_ ------------ Date _________________________________) Septic Tank (Specify Requirements) Disposal Field (Specify Requirements) --------------•== -•--------------------------------------------------------- ------------------------------ ------------------------------------------------------------------------- ----------------------------------------------------------------------------- -------- --------------------------- ------------ (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 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 Compens tion laws of California." Signed ------------------------ ---- -------------------------- - ---- Owner -- --------------------------- BYv6 --- -------------- ----------- Title ------- ----------------- (If of han owner), FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --- L` ---------------- --- -- ----------- DATE __. � / ------------ BUILDINGPERMIT ISSUED ------ ------------------------------------------------------------------------------------DATE ...... -------------------------- ---- ADDITIONALCOMMENTS ------------------------------------- ----------------------------'--- --- ------ --- ------- --------------- ----------------- -- --- s-------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------- -- - ----- ---------------------------------- ------------------------------------------------------------------------------------------------------------------------------------- - - - -- ----------------------------------------- - - - - - ----- ----- - ------------------------------------------ ---- -- ------------- --------- -- Final Inspection by: . - Date ------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M