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` FOR OFFICE USE. , . APPLICATION FOR SANITATION PERMIT 4 - 7 : . . - 4 .. • : ._ 1 - �,�` Pormit,No. _ 2-- _.�.� �.,. Cm s jp p:etemTriplicate) __. ...__.t___,5..� _ -.�_ ----- 's This Permit Expires 1 Year From bate Issued bate Issued Application is hereby made to the San Joaquin Local Health District for a/permit to construct and install the work Herein described. This applicationis made in compliance.witk County Ordinance No. 549 and existing Rules and Regulations. JOB ;ADDRESS/LOCATION f---- ------36_2,6__Ilar-v'y ------------ --------------------------------- - CENSUS TRACT Owner's Name --Geo,--- �. Phone 9827-Z3 Gy3 es - ----------------------------- --F ------- --' Address ---- SA Tie------------�l---------------------------------------------------------- FT City -- Stkn----------•--------------------------------------------------- Contractor's NameR aakkr__d.,�S__Se ti-c-__Tarik-_'�---- -----./----------------License # -_ Phone -- Installation will serve: ,i Re`sidence�Apartment House'❑ Commercial s❑.T,rgiler_,Court;❑_T. Motel ❑'Other i g e i Number of livin ' units:--].______ Number of bedrooms _2---_____Garbage Grinder ------------ Lot Size ___ __ ,I a� � ----- Water Supply,:_Public System and name _.______--______ Private ; -- e-1 ---------------------------------------------------, ---- ❑ . Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ;❑ �i Hardpan ❑ Adobe t9 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 fside.) NEW INSTALLATION: No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ SEPTIC TANK IJ Size-- -------:--•---------------------------------- Liquid Depth ---------------------------- Ca ,----- r Capacity -------------------- Type -------------------- Material-.-.,_.._•--- ---- "' -- -" 7qo:Compartments ------------------------ Distance ..-------- -'--------Distance to nearest: Well ----------------------------- -...Foundation ---------------------- Prop. Line ------------ -=k= LEACHING LINE No of Lines 7--------------------___ Length of each line_'e90....... -__ Total Length ,________911°_..'. ..... 'D'�Box _____d,---- Type Filter Material _____-2'!-----''___Depth Filter Material ------------ -------------- \� .� �. Distance to nearest: Well --------------------- Foundation I----;IQ_------------- Property Line. ........ SEEPAGE PIT [ ] Depth _ ---------- Diameter ______________ Number ------------------------- .Rock Filled Yes ❑ No; Water Table Depth Rock�Size __._-._______-= ------------�---------- t Disance to nearest: Well __--.__---,_.__-___ I -- -------------- Foundation ------�,_.�--`-.'_._- Prop. Line ----------------~---- �� t REPAIR/ADDITION(Prev. Sanitation Permit# --------_---------------- __---�----------- Date ------ -i_____ - 1 i_Septic Tank (Specify Requirements) yam' ----------------------------------------------------------- DisposalField (Specify Requirements) ----------------------------•------ i-----------------------------------------------"-----------------------------------•----------- 6 1 r . - ----'---------------------------------------- -------- t Lime--------- --------------------- - ----------------------------------------------------------- th` --------------- i (Draw existing and required'adciition on reverse side) II I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin Country 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 peimit is issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." BY.--�-r-=- -----------------------'- - Owner Signed ' ---------------------- ------------ Title ------- - (if other than owner) l I€ ! FOR DEPARTMENT USE ONLY i APPLICATION ACCEPTED BY - DATE J ' ------------------------- ---- -----------------------------------------------------------DATE --------------- -------------- ------------ ADDITIONAL COMMENTS _. BUILDING IT ISSUED �1----------- •----- - - ------------ -- - ---------------------------------- i ----------- - -------------------------�------------------------------------ - ----- - - ------- ----- -- ----- ---- ')-- FinaInspection by �IIWZ�--- ---.Date ------------ -------------- -------- -----------------------------------• SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M