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FOR OFFICE USE: APPLICATION FOR'SANITATION PERMIT 5��y Permit No. -a ------------ ----- ----....-- -'---'--- ----�-'-' -- y (Comp'lete in Triplicate) �5�:' ------------ Date Issued This Permit Expires 1 Year From Date Issued truct and ins l the work here-by mion is madeiJoaquin n co plian compliance hal eCounttyalth tOrdinan a rict for a Ner o, 549 and ex st g Rulesmit to constalnd Regulatonsrein Application is her described. This applicat �j C 4 j � > " �'!7 f � S' TRACT ---------------- JOB ADDRESS/LOCATION .----C� -.C-------- --- - - -- - ------------hone ---------------------------- ------- Owner's Name --'- - �- �� --' --------------------------------------------------------------- --------- ----------------- ------- ---'-- ' ---------- -- a -w � Address --- ��.�'-'-----' -----=- � -------------------------------- City -��f'.G��-h - -��`--- ------'-----/-/,� F ense # - g-- Phone - - Contractor's Namea�e� �` -------------------- Lic / � : Installation will serve.:: t Residence Apartment House❑ Commercial:❑Trailer Court I i Motel ❑ Other -------------------------------------------- Lot Size Yff >�-A 2 -10-rte----------- Number of living units--- ---- Number of bedrooms _2------ Grinder a. Private ---------------------------- j Water Supply: Public System and name ---------------------------- ----•-- ------ -- ------------ ----------- -- - Character of soil to a depth of 3 feet: Sand'❑ Silt[] Clay ❑ Peat E] Sandy Loam` Clay Loam ❑ Hard an ❑ Adobe ❑ Fill Material ------------ If yes,type --------------------------- i ,. p (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) �a . NEW INSTALLATION: {No septic tank or seepage pit permitted,i.f,public sewer is available within 200 feet, ] v i 1 t ------ Liquid Depth SEPTIC TANK' Size--- Q�-- -- ' PACKAGE TREATMENT [ � 4 hMaterial-G°� No. Compartments - ..---•- = ` Capacity /Z"------- TYPe 1" - f ` Lin - - Foundation _/A*-----------''Prop. Line ....Z------------- . Distance �to nearest: Well �'__s.�.��------------- -- - f ` ----- ------ Total Length ---------------- n LEACHING LINE No. of Lines --Y----------------- Length of each line---- g �/� -Depth Filter Material' -- ------------- D' Box FIE -- Type Filter Mafieriale I i Property Line. Distance Ito nearest: Well _. �--------- Foundation p tY / No .0 er ---'- ---- --- Rock Filled Yes Diameter Numb -- __-- SEEPAGE PIT Depth 12 IV I Rock Size _-_ -------------- Water Table Depth ----- ------- - �� _ Prop. Line -_-- . ,2-.------------- Foundation Distance to nearest: Well __-- ---------- __ I � '----------------1 REPAIR/ADDITION(Prev. Sanitation Permit# -------- .--------- Septic Tank (Specify Requirenr nts) ------------------- ------------ = '------------------------------------- --------------------- Disposal Field (Specify Requirements ------------------------------ -------------- -------------- ------------------------------------------------------------- ---------- - ___ _ __ --- - --- -- ---------------------------- ---------------------`- --- ---- --- ----- -- -- -------------------------- p - -------------------- � � � (Draw existing and required addition on reverse side) I herebycertifythat 1 have reared this application and that the work will be done 'in' accordance with San .Joaquin � County Ordinances, State Laws,Iand 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 to Workman's Compe tion laws of California." Signed ----- ------------- -- ------------------ ---- --_------------------------------- Owner • --- �------- --------- --------------------------------------- Title ------ -40"-1-- ------- ------------------------------- By ------------------ --- -------- By ------- ----------- - --- - �a (lf than owner} € p# FOlt EPARTMENT USE ONLY APPLICATION ACCEPTED BY - -------------------- F�T -- - "��-- ------------------ --------- ------- ----------------------------------- BUILDING PERMIT ISSUED -------�--i- `'- ---------------- y ar i ADDITIONAL COMMENTS --------'---------------- ----------------------------------'------------------ ------------------------------------' - -------------------- ---------- --- -=---------------------------------------- - -- s Date ------------------ Fina -Inspection b - - --------------- - SAN JOAQUIN LOCAL HEALTH DISTRICT f f .' E. H. 9 1-'68 Rev. 5M • +' } ' y F•� t'r