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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (, •� t. n Permit No. !l/-!-7!e --- ---------•------ ----------- --------- ------------------ (Complete in Triplicate) - ----------------------------- - - -------- ---------- - Date Issued .111-0-------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to cons firuct and install the work herein described. This applicafiion is made in compl'i'ance with County Ordinance No. 549 q{tid existin Ru s and Regulations: CENSUS TRA T _"---"----------------- JOB ADDRESS/LOC ON ` ------------ ------------------ :' �i e ---- ----------- ------- Owner's Namelti- - . _._ _,,� K n, i - .. tit Address --------------- - Address _ y Contractor's Name License # �7r� hone t Installation will serve: Residencea(Apartment House,❑ Commercial ❑Trailer Court i❑ Motel [] Other .°"_��_.�._-�",..t":="':_ � . �. � -r-Garba Number of living units:_ Number of bedrooms'. ge Grinderw: C�. Lot Size - -----------------------------------------Private�]` Water Supply: Public System and name -------------- -----------------"---- s�� Character of soil to a depth of 3 feet: SandSilt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ � Hardpan ❑?- Adobe'D Fill-Material -,tet l-Jf yes, type ---------- ----------------- ! _ s,x (Plot.plan,sshowing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) `A f.' :, vl NEWi1NSTALLATION: (No septic tank or seepage pjt permitted if public sewer is°available within 200 feet,) Liquid Depth ---------------------- PACKAGE TREATMENT [ ]� SEPTIC TANK'[ ] Size------------------------- ----- q P Capacity Type 'S- Material--------------'=-'-,-- No. Compartments ----------------- D;stance to neares#: Wel! -" - `:`-----Foundation^4"-------------------- Prop. Line ---------- ,------ a Total Length -------------- . ,[ l ------------------------ Len th of each*fine ' 9 LEACI;IING LiNE� � No�.�of Linesg --- --------� """" M^ ,- YP Depth F;Iter Material --- _ d.-' - ----------- - t� � ':per Box .___-"."_._ Type Filter Material __-".""_"_"-_""""_",Q�p �, a,Distance to nearest: Well ------------------------ Foundation' "- '� ---------- Property Line ------------------•=---- i ..; SEEPAGE PIT [ ] LDepth ------- -- ---- ------ Diameter Number = `1 �E ------- Rock Filled Yes ❑ No 0 M r 1. T-,-__Rock-Size ��•------------------•------- Water Table Depth =-` Distance to nearest: Well -------------------------- ----•-Foundation -r""_._- Prop. Line ---•---------••------- r ---------------- } � REPAIR/ADDITION(Prev. Sanitation Permit# -------- -------------------------- Date -- _ . = �_ "' -r ---- Septic Tank (Specify Requirements} --------------------- -- - , jam. ! - _ ---------------------- --- ----- Disposdl Field (Specify quirements) ----- -------- "' ---- -------------- a --------- --------------------- ------------------------- - - -- -- ---------- ----- -- - --- - -- cv1 ^ - -------- --- ---------------------' , ------------------------- --- ----------------- ---1--- ---- (Draw existing and required addition on reverse side) 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- G sed agents signature certifies the following: ."l 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 sul5jecto Workman s Compensation laws of California. l ' yt`t t ------------- Owner lieTitle Signed '- =-------------------- ------------ { e BY ''' -------------------------------'------ - 1 �, J � (If other than ow FOR DEPARTMENT USE ONLY ?4 i ----- DATE ~�d I APPLICATION ACCEPTED BY �� 1 DATE ------------------------------------------ BOLDING iPERMIT ISSUED -------- - ------- - ----------------------------- - �4 ------------------------------------------- NAL COMMENTS ' = ---------------- ------------ = ADDITIO y -------------- =-------------------------------------------------------------------------------- --- ----- ------------------ -------------------------------- --------- F-- -- ------------- -------- ------- --- _ ------ Date ---- - - Final Inspection b �✓ - =- "-- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'6$ Rev. 5M ° L -