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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ' •— Permit No: (Complete in Triplicate) ---------- - - `3 Date Issued This,Permit Expires 1 Year From Date Issued ---- $ Application is herebyImadelto the San Joaquin Local Health District for a permit to construct and install the work herein i described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: 9 JOB ADDRESS/LOCATION, _I` !__ ------ l E / 6� ----------------- --- ---CENSUS TRACT I _ �I ��_e--. ------------------------------------•------------------ ----------------------- ------ Owner's Name �f7- - -- --------- -- ---------- one,� � �(yy P ---- Address ------------ �`. rs Cit O -----------------•---- Contractor's Name -- s___/C.�-/•. - fir G ,/Ef��` --- License #f,�j�•`�� Phone 6 � I !J Installation will serv4eil Residence Apartment House-❑ Commercial :❑Trailer Court r 1 Motel ❑Other -------------------------------------------• a le i Number of living units:_--/- - GarboM__.__ Number of bedrooms ---,---- 5e Grinder / _1--- Lot Size eA -��4---` --- ---------Private,J9Water Supply: Publi c�Syste and name ----------- -_ L r+ Character of soil to a,depth of 3 feet: Sand❑ Silt C1 Clay ❑ Peat[I Sandy Loam ❑ Clay Loam aterEal _---- I;Yes,type --------------------- Hardpan ❑ Adobe El Fill M h j (Plot plan, showing€size of lot, location of system in relation to d veils, buildings, etc. must be placed on reverse side.) NEW INSTALLATION:! (No slptic tank or seepage pit permitted f�oublic sewer is available within 200 feet,] Z f iIEF f SizeLiquid Depth _� �. PACKCAGE TREATMENT [ PTIC TANK' w� .._ .. S 7'" I 3 Capaci#y ---- Type e--��` Materia[--- C1 - --- No. Compartments ------------- a ----------- ti Di! Foundation __ f� ---------- Prop. Line stance to%nearest: Well ��--------------- >� I 'I -. ------------'Length of each line- f� ---------- Total Length l_�r�------••_-•- -- i LEACHING LINE [ ] No'.,,of"Lines __ ® ------.. • D' Box V--'_ _ Type F71te Material`Z/ � "Depth Filter Material .�r1- ---------- ------•----------- D' --F } Distance to nearest: Well Foundation _✓ -�_.'i..-;- --- Property Line, -�a------------- w--- �- , '(I3 _ Rock Filled Yes No f SEEPAGE PIT [ ] Depth --, ��- --- QiIme#et -��----- Number ---rte---------------- inter Table Depth __� {- _- ---- -------Rock Size _. __�_ -------------- a _------------- f Distance to nearest: 1Ne11 _.__ ------------------Foundation -��_---_ f.Prop. Line --- fes A !' REPAIR/ADDITION(Prev. Sanitation Permit# --- --------- ----- - ------- Date ------------------_--- 1 t ; !A/ A Septic Tank (Specify lf6quirements) -------- - ---- --------- -------------------------- /------------------------------------------ --- --------------- i Disposal Field (Specify Requirements) ------------- --- -------------- --------------- : ---------- ----------------------=------------------------------------- Ij `r -- ---- --- - --- - - - ------------- ---- ; --- ------------------------------ - � (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 i�Laws, and Rules and Regulations of the.San Joaquin local Health District. Home owner or licen- sed agents signature certifies the following: r "I certify that in the perF rmance of the work for which this permit is issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California. I . Signed �r------------ Owner a. k ,� Title ------ Byy' ------------- ----------------- �L (If other n owner) FOR .DEPARTMENT USE ONLY + ' DATE _�_ �_._ •- ----------------- APPLICATION ACCEPTEDI�BY ----- ' ' ---------------------------------------------------- -- DATE ------------------------------------------- f BUILDING PERMIT ISSUED -�- - - -------- ----------- ---------- ---------- -------- --------- ------=--- --------- _ ---------- ----=---- ---------•----------- ADDITIONAL COMMENTS` - 7 A , --- C dU- i ---------- ----------------- lr = ----------- --- ------- -'----- --;------- i ate --- Final Inspection b �I ~ �-- ------------ --------- -----.gate ---� -- ------------------- -- SAN JOAQUIN LOCAL HEALTH DISTRICT t E. H. 9 1-'68 Rev. 5M. ►