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FOR OFFICE USE: APPLICATION FOR SANITATION PE T k -- - -- ------ g Permit No: _ �.__.. (Complete in Triplicate) ---------- -•------- ------------ This Permit Expires 1 Year From Date Issued � �g�eilrsued Application is hereby made to the San Joaquin Local `Heath District for a permit to construct and install the work herein described. This application is made in compliant _ dth-_C t D4ncince No. 549 and existing Rules and Regulations: r JOB ADDRESS/LOCATION. -- --a�----- -- ------------ - --- ------=--------------------------.-:----CENSUS TRACT ._ = _ _-_-_- �:-. Owner's Name Phone -- -. � �--•- a - ---- -- -------7-7/4._ Address --- ---- ------•------ -- - - - - - ------•--. Cit ,�--- ----- - Contractor's Name oe --- -- -- *---- -- ---------------------Lice *-M1g4W-------- Phone 4i5 __'9667- Installation will serve: Residence-Apartment Ho'pse-❑ ComAeo�a) ❑Trailer Court ❑ Motel ❑Other ---------------------- - .......! Number of living units.----/------ Number of bedrooms ._ _._--Gar age G ander ____-�_ Lot Size -f _ _'�'�--------------- Water ___--- -_ Water Supply: Public System and name --------------- �..------- ____-- Privat --- ------•- ----- ------ ------- Character of soil to a depth of 3 feet: Sand' Silt r, la P ❑ ❑ y ❑ Sandy oam ❑ Clay Loam,❑ Hardpan ❑ Adobe Fill M «Trial _ ------ if , type -------------------•----_--- (Protion, p - buiise side.) pg size of.lot locationof_system in relation to_vve�I ,_ ldings, Etc. must be placed on rev �_ NEW INST LATION: {No se tic tank or se4pa a rt permitted if public sewe is available within 200 feet,) 7 PACIICA-GE EATMEN Ca + _X 5 ------ ------------ ------- -tigai"e th -.. . .i _. . . � - No. Compartments _ ... .......... Capacity��A -K-- Type --- - -----Si-a---Material- - - ----- . Distance to, ne esfa.. e I '-- ------- _�-----___----Found tion ----1440 -------.Prop Line __.._ :. ;._--------- GI _ { LEACHING NE No. of Lines ------_�''---_ - Length of ea line------- -- Not `engtl ---- - ....�`-------- 'D' Box./____.-____ Type Filter Material � -__.._ .....Depth Filter aterial ` _ -•_�_ - -' Distance to f nearest: Well ____r_ _____ _______ oundation / ___- ----- Pr ,ne ___imo. r SEEPAGE Pf7� D6pth __- _-- i�iameter --- b ---- -----_- c-k-fiii�ecf Ye No j0 Water Tab Depth �/ .. ------- -•----Rock Size -- 6 �"---- - Foundation -_-•• --•------•__.. Prop. Line ....15 REPAIR }I ceo nearest: Well ---____f- ---- - - ----- --- ------- l a IT_ION(Prev. Sanit tion Permit# -_-------------- - ate ___. I �p Septic_�grtik (Specify Requirements) -- ---------- ------------- - - - ��;t Dis �s�al field S cif ...je men ,.l�; J . < F { p Ye X...._ } r 1. f Y-------------_________________4___________-________'-_._..______________-____.____,--_-_______-________--____'___________.___________-__-______________ 1 (Draw a isptingland required addition ` , # 4 c�iar on reverse side) I I[*,reby c ify}t a 44-prep r this a li. tion and that the_" will be done in accordance with San Joaquin County Ordinances„ tate Laws, art �Rles andegulations of the_San,Joaquin local Health District. Home owner or licen- Ad agents signature certifies the followin&%^ f " cevify tkat in the performance,of the kork�for which this permit`is,issued, I ,shall not employ any person in such manner a to become subject fo Work an'"omp,4tion laws of California.'' Signed --------------- ------------ - ----- --!----- ----- -- -•------------------------- Own er BY --------- Title (If other th wner) FOR DEPARTMENT 'USE ON APPLICATION ACCEPTED BY -= `--.f- - 00, ------ ------ DATE � a BUILDING PERMIT ISSUED - - DATE --- - - -------- ADDITIONAL COMMENTS - - = _ _.: -- �------- - ------------------------------------------------------------------------ - ' ------------ SAN - ------------------------------ ----- -------------------------- --- f---- ------------- ------------ -------•----------------------------------------- -------------------------------- ---------- Final Inspection by- --- --- -- --- -- - --- •------------•-- •----------•-------------.Date6 r _ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M