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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. _-: --- -9- --- -------• -- - ---- --- (Complete in Triplicate) --- -- ----- Date Issued 7 This Permit Expires ! Year From Date Issued , ---------- ------------------------ ----- I Z3 a- �,, " � . /+ �{�p�icat+on 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 an ex;sting les and Regulations: JOB ADDRESS/LOCATION �-s�-- - - 13fk_- / +� - j� N �.IS TRACT ---------------------•---- I Owner's Name °'`- - Phone ' C�� .� Address // -- ------------------------------- - City - � {r --�-----------------------------License Phone Contractor's Name __--- -- t - - - -------- - r Installation will serve: Residence Apartment House,❑ Commercial []Trailer Court ',❑ Motel ❑Other ---------------------------=--------------- ! � ( '- ' Number of living units:--- Number of bedrooms ---/------Garbage Grinder ---•---- Lot Size Private' Water Supply: Public System and name --__------------- ------ --------- -----------'----------------- ------------------------- Character of soil to a depth of 3 feet: Sand'❑ Silt Clay ❑ Peat E] Sandy Loam Clay Loam Hardpan ❑ Adobe❑ 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.) I p tv; NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer,is available within 200 feet,) /., W SEPTIC TANK S;ze_t --,4 -""." - --- -------- Liquid Depth PACKAGE TREATMENT [ � > .� � � - " - - X11 ' f'e��Q ---- T e�t�•-�f - Material- Capacity No. Compartments �� -- _-- - --- YPf Distance to nearest: Well __ �---------------- Foundation - ------------- Prop. Line - ------. Length oeach line- Total Length -90--------------•--"- ------ LEACHING LINE � No. of Lines ---------------.- g �� -��---- '--- ------ 9 h 'D' Box - Type Filter Material✓- �Aj --Depth Filter Material ------------•---- Distance to nearest: Well -��- -- ------ Foundation /fir-------- Property Line --------------- Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No `l SEEPAGE PIT [ ] Depth a � Water Table Depth _ Rock Size ------------------------------- ' --- Prop• Line -------•--------• Distance to nearest: Well ------------------------------------•..-Foundation ---- Date ---------------------------=------) .,. REPAIR/ADDITION(Prev. Sanitatiorn:Permit# ----------------=---- €: t -----------• - , Septic Tank (Specify Requirements) -------------------------------------------------------- {_ Disposal Field (Specify'Requirements) -------------- --------------- -------------------------------------- ------------------------------ I ./ -- -----------•--_•---_- _ ------------------ - _ -- -----------"-_ I. y ---------.•--------• ' -------------------------------------------------------"-___"--___---_---___--____---____---___-----__-------"-.___."---__--_-_----.._- --------------"------------"-------""--- -(Draw existing and required addition on reverse side) I ' 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 Reg ulatiionsIof 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 to Workrnan'slCompensati.on aws of California." Signed ---------------------- -------------- ------- - Owner ------------ --- ��,f ------------ ' ------- Title ---- ------�"=" ------ --------------- BY ---------------------------------------- - ------- r 4 (if other th - wner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----- ----- - -- ------------------------ DATE - ----- - -'---------------------- BUILDING PERMIT ISSUED ---- ------ - -----=----------------------- -- --- -------------=-- DATE - ---------------------------- -- - -- - ----- --- - --- -- ADDITIONAL COMMENTS ----------------------- ------------- --------------- l ----------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------- ------------------------ ---- - ------------------------------------------ rr Final Inspection bY� ---�-. -� ;" ---- ----- ------------- '�---.Date --..-�r .�-r-)-��--- ----------.------ ---------- ��' �. SAN JOAQUIN LOCAL HEALTH DISTRICT 'E!H. 9' �; 1-'68 Rev"5M ► k � ,',