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�YFOR CY�FICE.USE: APPLICATION FOR SANITATION PERMIT tt v"= t :3ZJ �: Permit, �r �L_ 3 •: (Complete in Triplicate) ---------- '`-- -------------------------------------- A }) # _______ This Permit Expires 1 Year From Date Issued Date Issued __ __ ___________________!____________________ F S 1 ; i Application "is hereby made to th San Jaaquin L&'ith h District for a permit to construct and install the work herein described- This application is ma ir'rjptrx�alianunt�Orc UnA �No. 549 and existing Rules and Regulations: VV +V[ i t JOB ADDRESS/LOCATION � � M __ .__ - Cy �_�. NSUSTRACTVr__-_SF ... *.k, • r_ Owner's Na --------------- me ------------------------ ------g- ------._Phone AddressCitY .��-------- -k4 ' ----- --- ----- Contractor's Name 41 --- - '�-- - - -------------------------License # /00-S-7-1----- Phone'-_�;4an.�.._ Installation will serve: r i Residence ❑ Apartment House-E] Commercial ❑Trailer Court, i❑ i M�tel ❑Other ...FAB-P-IC AI Il�/-G PL-AN T— I ! Number of living units:------------ Number of bedrooms ------------Garba_ge Grinder ._._ ------ Lot;Size ___________________________---______________ � Water Supply: Public System and name ----=-T------------------------•-------------------------------------------------------- ------•---- Private E f Character of soil to a depth of 3 feet: Sand'Q. Silt❑ Clay ❑ Peat ❑ Sandy Loam,[] Clay Loam;❑ T Hardpan Adobe Adobe Fill Material ____________ If yes,type _________________________r__ f0 r (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,l PACKAGE TREATMENT-)[ ] SEPTIC TANK " +1 Size_4-_?�:J ___x__ ______________ Liquid Depth - -Zt-________._____ Capacity _(:-7q(Typet — - __ Material--c a. Compartments —............... '-Distance to nearest: Well _t __________________FoudationQQQ_______ Prop. Line - . LEACHING LINE, ,,,No. of Lines \ L n th-9f each line- --------- -----------��_} �g F k-Q� Total Length -00 - 'D' Bax 1 •', . .. �7 Type Filter Material s�_�_��_Depth,Filter Materia! _I'._q_-----------.______________________ Distance,to nearest: Well 4-1-�`--_________ Foundation - _6___-_________ Property Line _/_ ______ SEEPAGE PIT -'Depth _2_�±_ Diameter:��'._�,Number,C _ •_ Rock Filled Yes No _z - '`Water Table.Depth _400 - --- -•Roclie 7-"--------- Distance to nearest: Well __ -----------Foundation -_ '_ �___-_ Prop. Line -.Ll ............. Y ro- REPAIR/ADDITION(Prev. Sanitation Permit# ____________________,___:_______.___I Date -_-_--___'__� ��______________J - r•" ' a -est- - �. Septic Tank (Specify+Requirements) --------- ----------------------------------------------- --------- ---------------------------------------------------------- Disposal Field (Specify Requirements) ------------------------ ---------------------------------------------------------------- r t ' ----------------------------------- ----- ---------- _____ ____ _ _____ µ -------------------- ____._______ _________ _ _____________---_-----------__--___-_.---.__�_- (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that thenwork 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: Vt7,j ✓. j '4w --» "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 becoms iect toyo#man's Compensation laws of California. 7 Signed __ Owner - - ----------- - ---- By ----- `z -�� `_ �L ---- ---' Title --------- - ._ - • ---------- r�" (If other than owner) . 4 " 3 FOR DEPARTMENT USE ONLY' APPLICATION ACCEPTED BY ---L.• --- ------ --- ---------� y -DATE ------ ------------ . i BUILDING PETWVISSUED'"-:,' --------= k ----------------------------------- -----DATE ------- ADDITIONAL COMMENTS / ""�'� -----�--------- -- - --- - ------ ------------------------------------------------------------------------------ --------- ---------------------------- ------ 41 -------------------- ---------- ----------------------------------- w . Sf r' kyl1,..r _.__ ___._ _ Final Inspection by. C - - ------- -------------•------------=---- -- ---- --- -----� -----------Date -------------------------i AN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M