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tiv�c vrsrC.0 VSE: .y"---- -- ---- ---- ------ ----- ----- ----- APPLICATION POR SANITATION PERMIT p 3 ..................................... (CompletoIn Triplicate! r _ � --... a Permit No. a�.[_iy 'r This Pe rrnit Expires 1 Year from Dat*issued .........S Date I's ,. • Application is hereby made to the San Joaquin local Health District'for permit to construct and Install the work h described. This applicatioiOs made in compliance with County Ordinanca e No. 549 and existing Rules and Regulations:, JOB ADDRErSS/LOCATION ...... . .... .......... R ... ,. Owner -- CENSUS TRA Owner's Name -....__...�.�•��.,��._...-_.�� . . ...... Address ..............Phone . y`' . �_.....__ Contractor's ................................--•-• City •-................................ ' Name .. ------------ - - • -.:: � ----•...................... __.License � Installation r ....' Phone ... will ............. .. serve: Residence 0 Apartment House❑ Commercial❑Trailer Court C] ' Motel Q Other Number of living units:-- --" - :Number of bedrooms ..----•--•-- ;� Garbage Grinder } 'nd name lot Size Water Supply: Public System s Character of soli to r` 't ................. •--._........ ....... ................ Private a depth of.3 feet: Sand P I ate ❑ •-, �: L7 silt p clay ❑ Peat y ❑ Sand Loom ❑, Clay loam ❑ ` � ,;s Hardpan 0 Adobe❑ Fill Material ............ if yes,type... (Pot plan, showing size of lot;(ovation of system in relation to wefts, NEW INSTALLATION: buildings, etc, must be placed -on reverse side. (No septic tank or seepage pit permitted if public sewer:is available within 200 feet,) PACKAGE TREATMENT ( ] 5EPT1C TANK 1 ��` Size... ff t C) 5.... �_.-------x- -_-.._ Liquid De th :.- P Type �h----y _J`' ►IAaterial. 1b' i.C _)._ No. Compartments ....22----�. istance. to nearest:.Well �1/ ...................... f} LEACHING LINE Fo ndation �'�- t 41,1 Lt.. Prop. Line _... .. ..._ _. No. of Lines Length of each line. -i�---L� - ----- ••---�•------•- - - --..._.__. Total Length D' Box _ g 1.._._... •............. Type Filter Ma#eriai ._ � 1 :••,Depth .Filter Material _•.....•--- . Distance to nearest: D timet��'--�•�.-• Foundation SEEPAGE IT { � Depth I -----• --- Property Line ............. ... ---------------- Number ...........•------.......... Rock Filled Yes C) No Water Table Depth ........ . ......... .... .... . .. ...._Rock Size •-•-••-- Distance to nearest: Well .........:..... `(` .. REPAIR/ADDITION,(P_rev.._Sanitation.�ermit+# ...................... Foundation .................... Prop. line ...................... Septic Tank (Specify Requirements .__•-----••--- Date ---:= ...--- Dis osal _-•-•----• --- --------• •... p ;Field (Specify Requ�ents) •-----. -•• 1 l f.= x � �. ... ,G� = �. ova - _ .-,...................... ------------- 4._. L�U� --------------------------------------------- • . - (Draw existing and required addition on reverse si-.d.e---••------ } _ I——... I hereby certify that I, have prepared this rspplication and that the wank will be done In accordance with San Joaquin County Ordinances, State Laws, and ftl_es sand Regulations of the San Joaquin Local Health.District. Name owner r see!agents signaturere certifies the foilo`wing: o Iisen- "I certify that in the performance of the work for which this per is issued, 1 shall not employ any person in such manner . as to become bject Workman's C pensation laws of Ca o ia." Signed ....... 7su . t --- -------------------- -- - Owner BY =---------- --- --- -- - 11 (If other than o rl Title ........................ FOR DEPAR ENT USE ONLY APPLICATION ACCEPTED BY _1--+-----�� BUILDING PERMIT ISSUED _._.:... ------ ---------------------------. • --- - - --- --- DATE ...117/7-7,S.. ADDITIONAL COMMENTS .._.-- '�:: '.. .;�----------------- � z -----•-- : - --- °, ----- -•-- -•--------• . ' ----------------------•-- ------------------ -- --.._.................---....._..--- . Final Inspection b - -- - " --- - ---- ---- -•• -- --...._----- ----- --- -- EH 13 2 --•.... ---....:................. ...... . .. � 1-6 t3 �v. � ° .............Date r----.........._�.-�--"--. .. SAN JOAQUIN LOCAL HEALTH DISTRICT 8/743M... .......