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FOR OFi 1C1: USE: APPLICATION FOR SANITATION' PERMIT Permit No. (Complete in Triplicate) Date Issued -------------J---_ This Permit Expires 1E Year From Dnte Issued Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is made'in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .- -= _ _% _- ---< - --------------------- - CENSUS TRACT .-------------•----------- 4 !/ ,� r_�. _2_s6-7'------------- ----------- ------------------------- ---------Phone ------------------------------------ Owner s Name _�.��-�^L�------- �/ __ ----- 1/- —> C ---- r�r. City t� Address _ � ---------- - Contractor shame --- __ f_ /� � � __ Phone =—--------•-•• r! L --- r --- =- -License GI Installation will serve: Residence ❑.Ap�ment House❑ Commercial:❑Trailer Court ❑ IMotel ❑ Other -------------------------------------:------ Number of living units:---_-------/Number of bedrooms ____Garbage Grinder �S' Lot Size Water Supply: Public System and name - ------- --- --------- - - - -- --- --- --------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay .❑ Peat Q Sandy Loam ❑ Clay Loam;❑ V Hardpan ❑ Adobe Fill Material --- yes,type ---------------------------- (PI,ot plan, showing size of lot, location of system in relation to wells, buildings, .etc. must be placed on reverse side.) k NEW INSTALLATION: {No septic tank or seepage pit permitted if public sewer is available within 200 feet,) Size_-- A':fry. -- Liquid Depth __j7 -� ---------- PACKAGE --- ---- . PACKAGE TREATMENT [ ] SEPTIC TANK, ,] ; + ---- vo :_4Zi�No. Compartments __ ---•----.... Capacity Type V_( i� —Materia Distance to nearest: Well ------511-- -------------------Foundation _� ------------ Prop. Line --- - --------- �. ------- = g 2f -ine_1_11�-.__?� f�c----- Total Length ��-------_---- LEACHING`LiNI [ Do. of XLnes Typ Length of" each Filter Material ---- --------------------------•• ___ a Filter Material ___ _ _ - ' { Foundation �J l Property Line _=`? ------ "� w '—� Distance to nearest: Well �.__ SEEPAGE PIT Depth -____ � Diameter _3�_________ Number --__c_7___:_t-f______ Rock Filled Yes No CC]� Y ` (_ . . !_t. Rock Size -:?�. '-- Water Table Depth �-------��- ------.--------- -.--• ---- ----------- Z7 I Distance to nearest: Well ____-. -------------------- _-/d____.---- Pro Line ---__. i REPAIR/ADDITION(Prev. Sanitation Permit# ----------------------- ------------------ Date --------------•-----•-------------) Septic Tank (Specify Requirements)=------------------ ---- -----------------_----------------------------- t , Disposal Field (Specify Requirements) ____,______ _ __ ---------------------"------' --"------ ---------------- [ ----------------- =------------- -------•-- ---------------------------------------------------------------- ------------------------------------------------------------------------------------ (Draw existing and'required addition on reverse sid ell I hereby certify that I have prepared this application and that the work will be done in accordance with Son Joaquin ` County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- f sed agents signature certifies the following: "1 certify that in the performance 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." " { Signed -- -------------- I ---- ------- ------------------------------- Owner. ------------- - - Title -- ---- - ------------- ----- ------ ------ ---------------- (If other than ow r) FOR -DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _._ - -- -- -------------=--------------------- DATE " BUILDING PERMIT ISSUED -----------j--------------- ------ DATE _------------------------------------------ ADDITIONALCOMMENTS ------------ ----------------- --------------------------------------------------------- ------------------------------------------- --------------------------- __ __ _ ____�__�_- ______ - "_____________�{_ _-f ___ ------------------------------------------M. .------------------------------------------------------'_ __ _ --------------------------------------- - ------------ --------- ------- -- ---------------- - f Fina! Inspection b ---- � --- -- - - --------------- --_Date __..-------------1--�- ---- •------, SAN JOAQUIN L CAL HEALTH DISTRICT 6) _ F,H. 9 1-'68 Rev. 5M