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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT I �/— 33V ------ ------ Permit No ----------------•-••-. { �,�-' "" "-""----' (Complete in Triplicate) _ ---•--- --- - - ----- •-- ----------------- --------- ,- Date Issued -----•----.^_._.. a This Permit Expires 1 Year From Date issued 4 --- ------------ Application is-hereby'made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with Country Ordinance No. 549 and existing Rules and Regulations: ] / I I t7 o CENSUS TRACT _ .---- JOB ADDRESS/LOCATION �. l.:L-(/( / Owner's Name �-� Ky �� - $ =,, /.�.� /._...Phone Address ...-...1� - Q--- -:. f •l-' 'lO •_.._..City JAI . _ Contractor's Name ._�UL(i _-_ - � ....License # - - ------ Phone - ----_------_----.-- I' Installation will serve: Residence partrr t F'ouse-[] Commercial OTrailer Court ❑ ' Motel (:]Other - / . fisc, ` l ❑` .. Number of living units:------(----- Number of aedrooms. Lot Grinder_l,_ Lor Size R T Private Water Supply: Public System and name - -••---------- --i----- ------ -------------------------------- --- ----- Character of soil to a depth of 3 feet: Sand ❑'Silt❑ Clay ❑ Peat Sandy Loam Clay Loam❑ Hardpan ❑ Adobe ❑ Fill Maferiol _(_Y- _ if yes,type ___-.'- ---------- ------- - (Plot plan, showing siie of tot,�location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage p•t permitted if public sewer is available within 200 feet,) Ile PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] Size'"-------•=---------------F - --- ------: _ Liquid Depth F Capacity Material 'N Compartments -•.............. P Y ---- -------- Type Distance to nearest: Well . . -.. . -_-Foundation -- ----- ------- --" Prop. Line - J LEACHING LINE [ ] No. of Lines ...... . . . ......___ Length of each,line...:___.-+'-----.- ----- Tota! ,Length ... 'D' Boxl.. --------. Type Filter aterial ....................Depth Filter Mat rial .._ •----•--••---•••••-•-- Distance to nearest: Well __ ------------ Fovndation .._.. 1.._.____ __ Property Line _______________________ f Diame er _ Number __._.`................. ... Rock Filled Yes :0 No o❑ SEEPAGE PIT [ J Depth ---------- - r ........... C j Water Table Depth _ Rock Size ------ ---- ---•- ---- Distance to nearest: Well . . . ................................ Foundation . ---- -- ._,Prop: Line -------.------_-•-•• C 4 C r Y Gni ;- .Date _�E F••----. --- --- REPAIR/ADDITION(Prev. Sanitation Permit# _....._..'- :---_---•---•- _ _u_.. ._, �` -••-------- ----------- ------ Septic Tank (Specify Requirements) ....._ __ - Disposal Field (Specify Requirements) ------ADL/-------•- -------------------------- d addition on re ` r ---- - (Draw existing and require reside) !p�Pared this app hcation and that the work will be done in accordance with San Joaquin i I hereby certify that 'I have re County Ordinances, State Laws, and-Rules and Regulations of the San Joaquin Loca} Health District.Home owner or licen- t sed agenti signature certifiesithe following: erson in such manner I "I certi in the perFo a of tho work for which this permit is issued, I shall not emp loy any A i as to bec subject t W m 's Compensation laws of California." i Signed Owner r -- � .: ..... Title . ..------= ------------------ - r (If other than owner) FOR .DEPARTMENT USE ONLY DATE f. --- } APPLICATION ACCEPTED BY [_ - -- .-� .. . _.. OM ISSUE _.. : t. _.----� - ± "T_ __4 (, -..QAT•E- = _=- ADDITIONBUILDING- PERMIT—ISSUED 1 1 & ,.i1.T --_-r.N. ..".- ADDITIONAL C - •• �--- --- .---. - - --------- - _,----.-- v._. - ------ Date . ----- - • .. Final Ins Tti -- �--- --- ---- - ._._.._ - . -- _',S' ASN JOAQUIN LOCAL HEALTH' ;DISTRICTF - •� gid! • E.H. 9, 1-'68 Rev. SM.