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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT } Permit No. --------------- ------------------ ----------------- (Complete i Tri lice to ------------------------------- 6.9 P, f` Date Issued AThiserrniEx fres ] ear From bate 1s d Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: q t ----CENSUS TRACT s-�_ .---_-_-- JOB ADDRESS/LOCATION ._1.f- -- ----+ LA_A�TCf ----------- ------------------ f� / 1? i= f:� ,vT r e cR t� c2 i t�r2-s__f°c Phone -- Owner's Name � '^ - _ _- -------z------ ----------------- Address J -1-- city h� G= �l / a -------- -- -- -----.License Commercial : Trailefi Contractor's Name __ ___ _ Pone Installation will serve: Residence g Apartment House❑ ❑ Court ;❑ x Motel ❑Other ---------------------------------------- -- Number of living units_____________ Number of bedrooms -------------Garbage Grinder _______ Lot Size ___ ___ _ -__ Water Supply: Public System and name ----------------- _ ----------------•-----•--------- Private Character of soil to a depth of 3 feet: Sand' Silt❑ Clay ❑ Peat❑ Sandy Loam ,E] Clay Loam 0 Hardpan ❑ Adobe.l] Fill Material ------------ If yes,type ________.__--__________--- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) ` NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) 1 PACKAGE TREATMENT ( ] SEPTIC TANK:[� Size-_ .... -- -- q P t , rr}} T'' _ �=frMaterial4r2�� No. Compartments _.t5..._____________ 1N . Capacity YFe = 06 Distance to nearest: Well --- ___-`---------------Foundation _.!_ --------- Prop. Line _ ---- LEACHING LINE [,4,-__N_o, of Lines ---------/---------- Length of ach ine------�J-O_----------- Total Length`-- --------------- ---------------- 'D' -------------- 'D' Box .__i:._____ Type Filter. Material J4_ -- __-De Depth Filter Material - p ------- -- I / /-----__ Property Line. _ .. I Foundation - --_._ _____ Distance to nearest: Well :_� ------ - � I SEEPAGE PIT [ ) Depth ___ Diameter I _____•____ Number -______.___----____� Rock Filled Yes 'D No 0 Water Table Depth-:------------------ ---------------Rock Size ------------ --------------•--- I ... Distance to nearesf 'Well --_______ ------------------- Foundation _______ - Prop. Line __________.....- dr ----------- REPAIR/ADDITION(Prev. Sanitation Permit# ----------------- ----------------- - Date ------------------ ) l Septic Tank (Specify Requirements) ---------',-------------'i Tlfi�G.L------------------------------------- ----- -------------------- ------------ ! Disposal Field (Specify Requirements) ------ - - - I- _� -----FA-I LI A! _ _l, 7`E ------ ------------------- -- - - ORD -f- ------- SU �...; ---------------------------------------- ---------------------------------------------------- j i (Draw existing'and required addition on reverse side) V •J I hereby certify that I have prepared 'this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, 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, I shall not employ any person in such manner as to become subject t Workma ' Compensation laws of California." 1 Signed ------- -- Owner --- --- -----= -- ------------ --------- ------- --- ------------------- �� ''` ------ Title By ------ If other than owner) FOR DEPARTMENT USE ONLY E APPLICATION ACCEPTED- BY"... F-T-R—a------ ----------------- DATE __�`_ < BUILDINGPERMIT ISSUED ------------------------------------------------------ ---------------------DATE ----- ------------------------------- ADDITIONAL COMMENTS ------------------------------------------- --------- ------------ ---------- --- - ------------------------------------------------------------------- ------ ------------------- - - ----- - --- -- - --------- ------------------------------------------------------------ --------------------------------------- --- --- ------- ----- --- Date Finallnspecti 46 ` - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M . l.