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'T FOR OFFICE USE: l i _ „ APPLICATION FOR SANITATION PERMIT -------------------------------- -- (Complete in Triplicate) Permit No. -2r:- - -- ------------ -------------------------------------`-`------ �_ __�I_____ This'�Permit Expires 1 Year From bate Issued Date Issued Application is hereby made to the San Joaquintlocal Health District for a permit to construct and install the work herein described. This applicationI is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION o � ------- -----CENSUS TRACT --------------•----- Owner's Name - - --~* l - :cPhone Address C --------------------------------------------------------- ----------------- `a� -2-----`= -/„� vt � �.i1------------------- 1 _. City _S 7`�.� Contractor's Name J f ��_ [ --------------- ----------------- License # Phone ,- Installation will serve Residences/Apartmeen`t House-E] Corf merciaf ❑Trailer Court ;E] Motel ❑ Other A--_' g � .” `m% r ms�--------Garba � Grinder�_•�..- Lot Size Number of livor units:---...._ - _Number of bedroo g s/. —� Water Supply: Publicystl�m and name -- -X G_-- ______ _( _ Private ❑ (J Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ 'eat❑ Sandy.,Loam '❑ Clay Loam ❑ ! F Hardpan ❑'. Adobe Y Fill Material ----4—A If yes, type ---------------------------- (PI'ot plan, showing size,i,of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side, � 1 I< NEW INSTALLATION: (No septic tank of seepage pit permitted if public sewer is available within 200 feet,) �ell PACKAGE TREATMENT 1-' „ : Sizef - Liquid Depth ., ti SEPTIC TANK'� � afrial - - ca, Compartments- Ype,. ter r DIistance to nearest: Well --------"'�� -------Foundation __ �------------ Prop. Line -- --'_.._�_._.__ iii - LEACHING LINE [y�]� No. of Lines ___c�- -' __._- Length ofeach line__ -X-�:_----- Total Length� `/-U-_�-_.._.__` �,. . li ,jam ' �"^ Depth Filter Material �:1 � D Box �-�f.�- Type Filter Material -�---------------- p , -- --..._---•---------•-------------- Dlstance'/o nearest: Well #_.___ `_--_---_ Foundation --.- U- ------- Property Line -_ --�_--._I.-.- . SEEPAGE PIT " ©!pth .----�------ -.- Dia eter ---- -- Number ______ -------------- Rock Filled Yes No C] Water Table Depth -----ve,,,' -r----------- ---------------Rock Size 4-1f�-2- ----•------ x qi k! �--�--� Foundation --�"� �----- .JProp. Line ---- 11: Distance to nearest: Well! ----------- REPAIR/ADDITION(Prev. Sanitation Permit# _.-�-- ----------------------------- ----- Date ---_- _----_--.----__---__-_-_-- -' Septic Tank (Spe ify Requirements) --------------------------------------------------------------------------------- ------ t I . Disposal FieldI(Specify;i Requirements) --- = ----- + (Draw existing and required addition on reverse side} j � I hereby certify that I have prepared..thi.s�application and that the work will be done in accordance with San Joaquin-- County Ordinances, State'j�Lows, 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 permit is issued, 1: shall not employ any person in such manner # as to become subject #o Wlorkmon's Compensation laws of California." Signed ---- ------------- 'I°' ----------------------------------------- O _ caner i ---- - �I . � ' � ------ -------------------- By 1 --- (If other than owner) r ` I� FO EPARTMENT-USE•ONLY- rAPPLICATION ACCEPTED(BY ----- - 't --------------- DATE ....= yr f '�/------------- tIJILDING PERMIT ISSUED ------ --------------DATE ----- -------------------------------------- ADDITIONAL COMMENT ;!--------- - -- - ------------------••--'---------------------------------_- ,j� ----------- _ --------- I J/t`-� ��J- --- -------------- ---------- --------------------------------•--------------------------------•--..._- --------------' =��' -fr ------------------- ------------------------------------------- --- ------ -- -- -- ------ - ----- ------- -------------------------- ------------------------------------------------ ,i`nal Inspection by: Ik ------ -----------------------. -----------------------------=Date --------- = �-------- F JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev, MIl