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FOR OFFICE USE: gppi,iCATiON FOR SANITATION PERMIT Permit No: -------------"- (Complete in Triplicate) wl Date Issued - ----��-�� -------------------------- - ----- °' ,� This Permit Expires 1 Year From Date Issued d S c 7z O3 D 't , Application is hereby made to thele n compliance liance wi h County ty Ordinance No. 549 and exstristing Rules tand Regulations. ,4 described. This application isrmit to con e + P 1 ��c r--r-b ri IC_ l _ %?. CENSUS TRACT ;: JOB ADDRESS/LOCATION Phone -----------------------------•------ Owner's Name .-__. _ � /�fA --- City __47<7 --------------- Address --- -- Address ------,�- --�-�P--�`- ��=- �.� - , � -- ------ --- - - ----- - --------License #��.c•"��=--- Phone -'�- =-�- -- - ------ . . t Contractor's Name =-�- �' Installation will serve: Residence 0 Apartment House❑ Commercial ❑Trailer Court ;❑ Motel ❑ Other ------------------------------------------ Number of living units:-./------ Number of bedrooms - ---Garbage Grinder - �-- Lot Size --------------•---- � _____"Private {� - ------------------------ - - ------- -- Water Supply: Public System an name -------------------------------- Peat - Sand Loam ❑ Clay Loam ❑ Silt❑ ' Clay ❑ ❑ Y Character of soil to a depth of 3 feet:"i Sand 1-1 , Adobe Fill Material ------ ----- If yes,type ---------------------------- j Hardpan � 1 (Prot plan, showing size of lot, location of system in relation to wells, buildings,- etc. must be placed on. reverse side:} .V it permitted if public sewer is available within 200 feet,) 4 v { NEW INSTALLATION: [No septic tank or seep a p' p s r d PACKAGE TREATMENT [ ] / SEPTIC TANK'[r Size_" --------- ------------ Liquid Depth " �-----------.----- r r7 _�No. Compartments --- rr Q YpQ_ Material-a- � 6� Capacity �_._- Type t 1 Distance to nearest, ------4-0------ ---Foundation ---iV----- Prop. Line _ + ---- Total Le LEACHING _ ,� - No. of Lines Length of each line-" P --- LEACHING LINE [''� ----�- ---"""-- - g � ---------------------------- 'D' � _ - r 1 � " th Filter Material � - - - e Filter Material1_1� _ � ep 'D' gox��ad -- Type � f - Foundation _Z$1---------- Property Line _.1-�d-'----•----------- Distance to nearest: Well - -- - - 1! l/ ------- Number ---- --------- )tock Filled Yes No SEEPAGE PIT t l Depth ..[-- --------- Diameter —'�— + ! f --Rock Size -----r-- --- ------ f O Water Table Depth------------ ! . I - -.Foundation ----47;0 ---- Prop. Line Distance to nearest: Well ---- t t]Zo . " Date --------------- ------------------ } w . REPAIR/ADDITION(Prev. Sanitation erm+ Septic Tank {Specify Requirements)T_- " ---- --------`--------------- -- Disposal Field (Specify Requirements) --- """-""- ---"----"--------•----------------""- -------------------- - ------------------------------------------------------------------------------------------------------------------------------ (Draw-existing and required addition on reverse s+ I hereby certify, I have prepared_thisiapptication and that the work willbedone in accordance with San Joaquin ,._ _- a�� , T- County Ordinances, State Laws, and Rules and Regulations of the San_Joaqu�n Local Health Disfrut. Home owner or-tcen- r sed agents signature certifies the following::. .. person in such manner "1 certify that in the performance of the work for which this permit is issued, I shall notemployany p as to become subject to Workman's Compensation laws of California." - yv--------------------------- Owner Signed ------------------------- ------ -}-- -------- :�C��/�- `--------------------- Tit1e 4 ° BY - r {Ifof ban owner} FOR .DEPARTMENT USE ONLY DATE _` =�f=Cln APPLICATION ACCEPTED BY ��` - --------------DATE --------------- -------------------- ------ BUILDING PERMIT ISSUED ---------------------------------------------------------------------- ----------------- ADDITIONAL COMMENTS -- `.------------- --------------- - ----------- -------------------- --------------------------- ---- ------------------------------ - i---- ----- --- --- -------- ------ ate -- ------------ Final Inspection by; . -- - - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M