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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT �j -------------------- - ------------------- ------ Permit No. (Complete in Triplicate) ------------------------- This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to constr ct and 'i all the work herein described. This application is made in compliant with County Ordinance No. 549 and a ting Ruff! areegulations: JOB ADDRESS/LOC ON ._l._ - .--00°_ - ------ --- --- --------- .--t/ TRACT _----�--"._.,_!___--- w er' Name _-: �-'�L rL�-------- ;-u Phone ------------------------------------ O n s , s I N��- n � ---------------------------------------------- Address ------- ?5 h--- ��.,1-7 `�' City - ---- Contractor s Name 1*i'i9l[L� ------ ----��f��/7 f--- License # ------ Phone Installation will serve: Residence P�Qpartment House❑ Commercial []Trailer Court ',❑ Motel ❑ Other -------------------------------------------- Number of living units:----!:------- Number of bedrooms--3______Garbage Grinder ------------ Lot Size _.� _ __ _.__._ _ _____-_--- Water Supply: Public System and name --------------------------------------------------------------------------------------------------------------Pri to Character of soil to a depth of 3 feet: Sand' Silt Clay Peat Sand Loam Clay-Loam i P ❑ ❑ Y ❑ ❑ Y ❑ Y' ❑ Hardpan ❑ Adobe5( Fill Material ------------ If yes, type -------- - ----------------- (Plot plan, showing size of lot, 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 [ ] SEPTIC TANK f ] .Size------------------------------------------------ Liquid Depth ---------------------.------- Capacity -----------------•-- Type -------------------- Material---------------------- No. Compartments ------•--------------- Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line ----------------------- 1, _-------- :-------- LEACHING LINE , No, of Lines --------I-------------- Length o e ch line__----- -Q---�---__ Total Length Wil- - __�__.____ /� ✓ `` ` r 'D' Box ---- f_ Type Filter Material ._Depth Filter Material _______!- __ Distance to nearest: Well _ _--_____ Foundation -----------A7V---- Property Line __________ _____________ SEEPAGE PIT ] Depth -------- ------------ Diameter ________________ Number ----- ----___-___. Rock Filled Yes ❑ No ❑ Water Table Depth--!------------ :!-----------------------Rock Size ------------------------------- Distance to nearest: Well ---- _ ---------------------------------Foundation -------------------- Prop. Line --_------------------ REPAIR/ADDITION(Prev. Sanitation Permit# -------- ------- Date ________--___-__________________-_) Septic Tank {Specify Requirements) -------/_-_7-------- ------ » - -------------------------- --r-- Di sal Field pecify Requireme;is - - =---- ---- -1 1 -- '� -------------------------------------------------- --------t ---- -------- ---------------------------------------- - ----- --------------------------- -- ------------------------------------------------------------------------------------------------------ (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 Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to bFAlr1dQWR`ft Rl.,lM0[kj€1 M'!6gpMeEsat'son laws of California." P. O. Box 254 Signed -- - - -- -- -- - ------------------ - ---- - - - ------- 160 East Grantline Road Title ---- ---- ---- ------ ---------By } o i-PAIIURr *37 Y F/ R DEPARTMENT US PMY APPLICATION ACCEPTED BY _ ------------------------- 0 -- = rDATE __l! - _- BUILDING PERMIT ISSUED --------------- ---- ---- --------------------DATE ------------------------------------------- 16 A COMMENTS /� �,Ei Wills-_ e �c _J �F_.__s�fr:�_&_>�- - ------------------------------------------ --------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------- - --------------------------------------------------- ---- --------- s - --- --------------------------- ------- ------------------ ----------- Final Inspection by- -------------------------------------------------------- - -- -- ------Date �G: I' SAN JOAQUIN LOCAL SALT DISTRICT E. H. 9 1-'68 Rev. 5M