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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ��!�-- �� Permit Na. --- ------ - /,, �- ----------------- (Complete in Triplicate) ----------------- Nle - - _ - �. Date Issued --' r�- ' t This Permit Expires I Year From Date Issued l the work rein Application is hereby made to the'San Joaquin Local i h Cou tHealth Ordinan a No. 549 and existing Rules for a permit to construct and tand Regulations: pp application is made in compliance described. This appAl CENSUS TRACT ---- JOI3 ADDRESS/L ATION .-I - n Phone ------------------------ ---------- ------- Owner�me _ e ��---- :-- ------------------------- w Cit --- t - Addres . Q_410 _ �'- _... Phone Contractor's Name -------- --.License # A . e❑ Residence part ent HousCommercial ai er Court �❑ Installation will serve: ' Motel ❑Other -------------------------------------------- Lot age Grin er _.__- Lot Size ____-- ------ Number of living units:__._-�---- Numbe bed oms __. , ----- ---private ❑ ' a _ Water Supply: Public System and nam -------- - Clay Loam ❑ t 'Silt Clay Peat❑ Sandy Loam .� Y' I Character of soil to a depth of 3 feet:..-Sand:._ ,fl,. _ � �� e e Hardpan ❑ Adobe Fill Material ------- 1f yes,type I �� on (Plot plan, showing size of lot, location of system in relation to wells, buildings aVpcilable within, must placed reverse side.) i p seepage �t permitted if public sewer NEW INSTALLATION: (No sept tank or see a e p p F ! '" Liquid Depth -------------------------- ( SEPTIC TANK:[ I Size------------------ 'Material ---------------- t-, s PACKAGE TREATMENT ( � 3 Ca acifi TYpe 'Material -�= ----- No. Compartments --------------•--_...• 1 p Y =----------- 1, . `..�' Foundation ------------------I--- Prop. Line --------------------•- Distance to-nearest:-.Well._-- ------ i # Total Length ----------- --------------- i LEACHING LINE- ( I No. of Lines1_,_-___Type -------- ` Length of each line-----_- - t De'th Filter Material ---------------------- --- Filter Material --- ----------- pD' Box i_ Property Line _ Foundation - ------------ ----- -- Distance to nearest: Well -------------------- --- Rock Filled Yes ❑ No 1" Diameter Number ---- - C SEEP PIT [ ] Depth 1---------- •. s Rock Size 1 f Water Table Depth ----------------------------------- 10 1 ----...........- ---Foundation _. ----- ---------- Prop. Line --------------•------- � � P Distance�to nearest: Well _________--__---- -- _ j, ` I _.' ' Date -----------------------------------) I REPAIR/ADDITION(Prev. Sai)itati'on'Permit#�---------------------- �x t ------l,.-------------------------- ----------------------- ecif Re uirements) ___.__ _ '` --------------------------------- --- -- ------------ Septic Tank (Sp Y q E:' . --- i= Disposalpie ( ecify :Rere nts) -1�, t *+ ! / -- --------------- '" Vii'."- r _ --- - ------ - l ------------------ i - ---------------------- ' �. • _°ti -- fi, 1Draw existi nd required add' ion on reverse side) M* . t . � fi i i I hereby certifyithat I have pre this application and that the work will pbe done in accordance with San Joaquin County Ordinances, State Daws', and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: t person in such manner "1 certify that in the performance of the work for which this permit is issued, 1 shall not employ any as to ec subject to Wo kman's Ca�penso ion ( California." � �.d 59 � Signed � ----------- - .• � Title ----------- ------ ----- ------ ----- ---- ...-- __ __ ___ _ BY (ifotherthan owner) 1 OR T USE ONLY DATE:.-- -- --------- -- -° ----- ------------- ---- ----------- - - --------------- ----------------- -- ------------- DATE ------ ------ ------------- --------------- APPLICATION ACCEPTED BY - BUILD1NG PERMIT ISSUED ----1:---- ---------- ---- ------------------------------------ ,.d ,.. :.- -'-. . . R '--- ---"---- _-:__--------- ---------- -------------------- ---------------------- --------- ---=------------- ---- ------------------ ADDIfIONAL COMMENTS _.__ +------ _ -------------_------------_____________________--_{______-____ _ _._ _ ___._..Y___-__ __ _- _ -------------- -------------------------- Y____„_------------------ -___- _-.._.._ -/-)•__ - ---Y - _ __ __ _ Al ------------------ ----------- ------- ----- Date � --------------- - ----- ------ ----- ---- ------- ---- ----- - -------------- - - ------- _ � J Final Inspection b ' ' - --- -------------- -" - -------- -- -- - - SAN J A IN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M -