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FOR-OFFICE USE: . APPLICATION FOR SANITATION PERMIT Permit N ----- -- --�---------�------ - - o. ------------------- (Complete in Triplicate) ----------•---------------------------------------------- Date Issued _ ---------------- This Permit Expires 'I Year From Date 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 incompliance with County Ordinance No. 549 and existing Rules and Regulations: LOT t) -b n JOB ADDRESS/LOC TION /---------nj_,4X FLL--------------- ------------------ ---CENSUS TRACT "- -------- Owner's Name --+'II-rL�-�- �SQU / �iY- 4rQ -------Phone ------ ----------------------------- Address � I3��e city- _ __ ------- -------------------------- -- ATN R 4-C-------------------------------------- --•--- Contractor's Name N1 L1.1-P 5------ [E9NS7 C `-------------------------License # ---------.-------------- Phone ----------------------------- Installatiorr Will serve—i"'—'""-Residence WKPI-artment-House❑-Commercial-❑Trai ler Court- ❑ Motel F-1 Other ----- - ------------- --- --- - - Number of living units:-----f-____ Number of bedrooms _ -___--Garbage GrinderyS�LotSize --� _-_ -_-�Q --_-____--_ Water Supply: ,Publ.ic.System,pnd name -------CkT ------AM T_M-_`----_-_-__-_- --------------Private ❑ Character of soil to a depth%of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat 0 Sandy`Loam Clay Loam ❑ Hardpan ❑ Adobe 0 F^' ill l�U�aterial �-y yes;typ !V if e i 4 (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 seep pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT { ] SEPTIC TANK Size___Afe) X_ -^.__---______ Liquid Depth.='/� -.--.----- � I A i Capacity JZQ�_--- Type PhORED Material-C0/VC�T_-_ No. Compartments- Distance ompartments Distance to nearest. Well _--5fI-W__________________Foundation ----/0------------ Prop. Line LEACHING LINE j►� No. of Lines ------ ------------- Length wench line__�1/-5-------------- Total Length __ lye)------/ D' - -- D' Box � - Type Filter,Material -Depth Fitter, Material -----_�_1.-- --'_�....... ............... Distance to nearest:,Well -__<: -_- Property i --_ Foundation [-.-1Q_-- Pro er Line SEEPAGE PIT [ ] Depth - Dia-ie Numbe ---__� k„Filled Yes ❑ No i❑ �,Water Table-D-epth --------------------------------------= ----- Ro&Size ------------------------ --- ., I Distance to nearest: Well -------------------------------------•--Fogodation -------------------- Prop. Line ----- REPAIR/ADDITIOW(Prev. Sanitation Permit# -------------------------------------------- Date ---_----------------------.-------} Septic Tank (Specify Requirements) ------------------ --------- ------- ------------------..--------------------•------ Disposal Field (Specify Requirements)------------------- -------- ------------- ---------- W�-----------------------------------•------------ - -- - -- t-------- ------ -- -------- --------------- --- -- ---z 4-------------------------------------------------------------- - ------------------=-------- ------------------------- -- --- ----- -- ------------------ - -- (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- sed agents signature certifies the!following: "I certify that in the performance of the work for which this permit is issued,.l shall not empl y any person in such manner as to become subject to.Workman' C mpensarion laws oflCajiforni- Signed --- ------------- ---------- --------Owner----- - BY ---------------------------- ----------------------- -- -- ------------------- ------- Title --------=-------- ---------- -------------------- -------------------- (if other than owner FOR DEPARTMENT USE ONLY Q.�S A1- DATE 1” 19--_6-7 •---------- APPLICATION ACCEPTED BY -.--- _�-_ r- BUILDING-P-ERMIT—ISSUED --- ------------------------- _- ADDITIONAL COMMENTS ..._ --_,_ r= ;_t ,. . ------------------------------------------------------------ - q- -------------- - ------------------------------------------------------------------------ -------- --.----------------_.--------____-._--_------------_-_-----_--_____-------_-----_--.-_-----__----.--_-_----_._ -------------------------------------------- - _- - - - _-- -- - - -----' - Final Inspection by -------Date ---�'------------------------------------ SAN :----3"'------------- ---- --- SAN JOAQUIN LOCAL HEALTH DISTRICT ` E. H. 9 1-'66 Rev. 5M