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FOR OFFICE �,SE: - y APPLICATION FOR SANITATION PERMIT ' (Complete in Triplicate) Permit No.------ ----------- -------------- ---------------------- - ---------------------------------- This Permit Expires ] Year From Date issued Date Issued 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 County Ordinance No. 549 and existing Rules and Regulations: JOB .;ADDRESS/LOCATION _d�� .--- ---- UAJE l------ ......CENSUS TRACT -------40-------------- - Owner't 'Name '----------------------y------- ----- Phony. .` a Address __----233- -- -�.�OI_T n'l.o l V ____ - . Citv :i _ ----------- Contractor's Name _M©Nk)RC0---14A1-KC-5--- VIC,------------- ''1----------.License # -------- .-- ------------ Phone ------------------------------ Installation will serve: Residence 214"artment House❑ Commercial ❑Trailer Court i❑ \,I Motel [.]Other _--------------------------------- _ -------- ,g� Number of-Jiving units:------I----- Number of bedrooms ______Garbage Grinder ..A!-O-- Lot Size CR Ham________________ Water Supply:-.Public System and name ----------------------•------------------------------- ------------------------------------------------------Private Character of soil?to a depth of 3 feet" Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam K__�Clay Loam ❑ + Q Hardpan ❑ Adobe❑ Fill Material -___ If yes, type __-______________________ (Plot plan, showing size,bf.dot, location of system in relation 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 5ize_____'f�X�fJ__�._�_ � ____________ Liquid Depth-._�._ -.____-_ � { ] SEPTIC TANK k . i l_1� c yp �-*-&M_iMdterial` 'Q_ kZ�_- .No. Compartments �~-- Capacity �l _C T e _ _ -- Distance to nearest: Wellf Sif __Foundation --------- -.- Q Prop. Line -------------- .._ LEACHING LINE � No, of Lines --------------------9—Length of each line------------------ Total Length ------ ----- 'D' Box _F_5_ Type Filter Material S_�_R605-,Depth Filter'Material _____ 1`�____________________________ -'- - - cam---�. Disttance to nearest: We[['::__� "=��-_.__ Foundation-:.___-'__- - Q_--_ Property Line. ---------_----_________ SEEPAGE PIT [ ] Depth _-_________________Diameter Number --- __._-�._________ Rock Filled Yes ❑ No 0a < - w„ Water Table Depth ?, .Rock Size:' `---------------------- Distance-'to nearest: Well.?------------------------------------ Foundation ------ Prop: Line .--------------------- �, REPAIR/ADDITION(Prev. Sanitation Permit# __Z;_'. ____-__-_ '� Septic Tank (Specify Requirements) -- -------------"-£----A--.-----'-'-"--'-,-.-,-----;-D--�-a--t�-e------ ----------------------------------------- ----------- ----------- Disposal ._. Field (Specify Requirements)�t- == y--.----i------------------------------------------------------------ ` -------------- -------------------------------- ---------------------------------- - ------ ---------- -----,- ----------------------------- r # 1 f ti ---- ----- ---------------------------------------------- (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,.,kand Regulations of the San Joaquin Local Health District. Home owner or licen= sed agents signature certifies the following: 4 . "I certify that in the performance ofthe work for which this permit is lssuea1l.shall not employ any person in such manner as to become C ct to Workinpn's Compensation laws of California." --� Signed.__ t _. ----- - t � � r: � -� owner By :.,_�? � - �.r-0 - = Title {!f other than owner) FOR DEPARTMENT USE ONLY ,I APPLICATION ACCEPTED BY > -------------------------- ------------ ------------------------- DATE ------ --------- BUILDING PERMIT ISSUED ---- _ ---------------- ----- --- DATE •.. _. - -- -------- ADDITIONAL COMMENTSF� 1n --'--- --•----- ------------------------------------------------ - •----------- ----------------------- --------------------------------------------- ----- ----------------- _ Final Inspec i - _ = ------Date ----------- -SAN ----------SAN JOAQUIN,-LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M ' S