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FOR OFFICE USE: APPLICATION-FOR SANITATION Pf"iff -------------------------------------------------.----- n - --------I---------------------------------------------- (Complete in Triplicate) Permit-No: ------------------------ ------- This Permit Expires 1 Year From bate Issued Date Issued Application-is hereby ffado,to-th-e-san j- t6cal--Health-District for -a -permit--to-const(6' g/, rLLpCt-9nc1- installZthe w&k herein described. This application is mdOle'.qn,,compliance'%With'Cdufit rdinance No'. 549 and exUlft _c�d Regttlations. y, orf ----------------- --- -- - ------------CENSUS-TRACT Name ----------1-7,1cli'ado-----------------------------------------------------'Phone ------------------------•----------- Address --.-------- A d S ---------------- dress ----t -71-Z------ ----------------- ------------------------ City 14_"6e.. ....... Contractor's Name -9_4 Wag/ ---------------------------------License 0.:2 ---------- Phone Installation will- serv6. 'Residence DjApartment-House C]-Cornh-iercial-E]Trailer Court V_ Motel E]Other 12 Number of living units:---_ Number of bedroornis" -----Garbage, Grinder-------------- Lot 9i.z'e--:/4C7 _e,,� ------e---------- Water Supply: Public System and name ------------ ------------ ------ --_--------------------r." --------------- --------------- --------------Private Character of soil to a depth of 3 feet.. Sand'E] Silt E] clay E] peat 0 Sandy Lo.am jfr-'!' lay Loam F -Hardpan Ej Adobe-[] Fill Material I%-- If yes,type ------ ----------------------- (Plot plan, showing size of lot, location of system in relati to wells,- buildings, etc. must be: placed on reverse side.) NEW INSTALLATION., (No septic tank or seepage pitpermi ed if public sewer is available Mthiri 20f.0 feet,) PACKAGE TREATMENT SEPTIC TANKf ---------------- S e __ L quid Depth --- ---�2m------------- Capacity Type PICA&------ -- a. Comlpartme ----------- nts Distance to nearest ----Foundation ....to---- ------- prop. Line -_,_t--__-•-.:... ..-- tr--- ... LEACHING-LINE!' . ' ...... each line--------- ----------------- To 31 f,LeKgth ------------ V Box ------------ Ty .pe Filter Material P44---Depth Filt6r Mateflal k ----------1_-...------------- Distance to nearest: Well - - - - ------ ------- Foundation ------- --- rderty Line .............. SEEPAGE PIT Depth -------------------- Diameter ___'X---------- Number --------------------------- i Filld Yes --- ckeNo ,0 Water Table Depth ------- ----------------- --'=-----------I -------Rock Size ------------- Distance to nearest: Well ---------------- - --- -----------------Fou,ndatiog"--------- �Pr6p Line -------------- ........ REPAIR/ADDITION(Prev, Sanitation Permit -- -------- ---------- Date --------------I-------- - Septic Tank (SpecifyRequirements) -------- ------ --------------- ------------------------------------------ -------------- ----=---------------------------•------- Disposal Field (Specify Requirements) ------ -- -- - ------- ------mmm,----- -- ----- -----2- --------70., ------ ---------------- _44EAC1 ------------------------------ ---- ------ ---------------------------- ---------- --------------------------------- -------------------------------------- rdlw existing and required addition on reverse side). I hereby certify that I have prepared this application and that the 4",ork will be .done;in,,*coidance with San Joaquin County Ordinances, Staife Laws, and Rules and Requitiflons of the San Joaquin Local Hecil&'bislrict. Home owner or licen- sed agents signaj ture 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 Compensation laws of California."' Signed--- 4 ------ -- -------------------- ------------------------ Owner, By --------- -- ------ Title'-------------- - --------------------- (if other than owner) It- PAiT f1itNT USE ONLY APPLICATION ACCEPTED BY----- __?---------------------------- ------ ------------------------- -------------- DATE BUILDING PERMIT ISSUED --------- ----------------------------- -----------------------------------------------------------------DATE ADDITIONAL COMMENTS -------- -------- -------------------------------------------------------------------------------------------------------------------------------------------- ------ ------------- ------------------------ - ---- --------------- --- ---- ------------------- ------------------------------------------------------------------------- ------------------------------------- ------- ------------------ - ---- -------------- ----------- ------ __ __ - ---------- -------- ------------------------------------------------------------------------------------ ------------------------ -- -- ----- - -- ----- ------------------ ---------------------- -------------------- Final Inspectl ------ ------ ----------------------------.Date ----- ------------ ------ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.