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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT , ff Permit No. 7`'`�_ �'r•••° (Complete in Triplicate) Date issued ...... This Permit Expires 1 Year From Date issued i Applicationand is hereby made to the San Joaquin Local Health DistrictOrinarnce permit install No' 549 and exting ng Rulesand Regulationsrein application is made in compliance with C Y described. This -• CENSUS TRACT l JOB ADDRESS/LOCATION .... ..........:...... Phone Owner's Name r .lC. c�='S ............. . ® ..........._......... - -•• -----....... City . Address _.._s7 _ a�.....1. ..� _.License # Phone Nl Contractor's Name —. ial nTrailer Court ] Installation will serve: Residence Apartment House-0 Commerc Motel C]Other .................... •------ --------------- 0 r ; . - Garbage Grinder .---......-. Lot Size .-.. - Number of living units:...:-- Number of b rooms ` .-- - Private Water Supply: Public System and name Peat❑ Sandy Loam fl Clay Loam ❑ Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay ❑ _ Hardpan Adobe 0 Fill Material ............. If yes,type F (Plot plan, showing size of lot, lacafion of system in relation to wells, buildings, etc. must be placed on rove rse side.) NEW INSTALLATION: (No.:septic tank or seepage pit er�d„}f public sewer is available within 204 feet,) 6 . Liquid Depth ......:................... 1 PACKAGE TREATMENT I ] SEPTIC TANK� I � Size....... •......................... t No. Compartments .............: S ... Material.- - Capacity .................... Type .:S Foundation Prop. Line .......... ........ .............. Distance to nearest: Well .......:.....•-••-.... f ` ,�'� Length of each line.-.1047- .-•-. Total Length .��+�.............. l t LEACHING LINT: No. of Ll _.. ......_ r �} �$' O Depth Filter. Material. --� --••--••---- 'D' Box TypeTFilter MaterialA41p r i Distance to nearest: Wel � ..---- •f Foundation Property Line ................ : . . ............. �f �-].a�1 -' - Number _..... Rock Filled Yes No ❑ f� Depth .- $ Diameter �......_....- SEEPAGE PIT �JJC p �„^—.•— Rock Size ..�.. ......�._...._._.. -Water Table Depth •r---••-• .................. Distance to nearest: Well _.--•�•= ---•-- -• --- Foundation .-.,� .....__ Prop. Line ..-----•---• L Sanitation Permit 56E Dote ...... ...... REPAIR/ADDITION(Prev. •-------•-•• ` ¢�y - ...... • -••-••---.....•.............. ' Septic Tank (Specify Requirements) ----•-••----....•_..------- - r ._ =---••--•--•••.......-- i Disposal Field {Specify Requireements] t r- required--------- ----a ----------- ---•-•------•--------- ----.-.-...-...Draw- - --•-exist in•- - -• - • -q on req--and add verse side) Y that the work will be done in accordance with San Joa uin� 1 hereby certify that 1 have prepared this application and County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. home owner or liceWJ sed agents signature certifies the following: I "f certify that in the performance of the work for which this permit is issued, I shall not employ any person in such mannevi as to become subject to Workman's Compensation laws of California." I ........... ....••.........._---. Owner Signed .:..............:............ ...-.... ........................ Title . ...... 4 (I other than owner) FOR DEPARTMENT USE ONLY �` DATE........... ....... ..... . ........•- APPLICATION ACCEPTED 8Y ............... :.y� f DATE _....-•..................•- ....... .. BUILDING PERMIT ISSUED _. ADDITIONAL COMMENTS ..- �..... ...... -_--•-•............................ •-•-•----•--••-- -----•........- ...--•-- ....---•............. .. -....----..... --•--•--••-••-••••...... -••.Dater `.. P'�-- .. Final Inspection by: _..:....�.• -�......................... ---- ---- •-• • --- • SAN JOAQUIN LOCAL HEALTH DISTRICT G 7/72 3 7 -A 24, 14 Ds.; 4AA _