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APPLICATION=�' x FOR OFFICE USE: N FOR SANITATION PERMIT ., Permit No: ----------------------------------------------- (Complete in Triplicate) ,� Date Issued --- - �----•• ____ ---------------- p ------------ ---------------- _ This Permit Expires Y Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein PP jai Regulations- described. This application is made in compliance with County Ordinance-No. 5 49 and existing Rules and Regu ations- e C- /0/---- --CENSUS TRACT ---- --------- ; JOB ADDRESS/LOCAT - -7 - - -- P ne - ---------------------------------- ------------------Owner's Name -------- itya --- --- q -- ----------- Address _. --<� �' - 1 a� t ----- Phone ------------------------------ u �" artment-Ho -License # Contractor's Name ti. s Residence, Ap se❑ Commercial ❑Trailer Court l❑ �� Installation will serve: f r, �. � .� � Mot ❑Other --------- --------:---------- - Number of living units:."_.- --___ Number of bedrooms _�----Garbage Gander ._----_-_-- Lot Size -------------------------------------------- Number ---------------- - •- ----- ------- - ------------- Private/ Water Supply: Public System and name .-_--____-_ Clay Loam Silt Clay Peat❑ Sandy Loam ❑ Character of soil to a depth of 3 feet: Hard an 1❑ ❑ ❑ .Fill Material --__-.------ if Yes,type -------------------- ------- � - p Adobe' - F. laced on reverse side.) io (Phot plan, showing. size�of lot, location of system in relafiian`ao wells; buildings, etc. must a p. _. -- ,t permitted if public sewer is available within 200 feet, O NEW INSTALLATION: (No septic tank or seepage p' p Liquid Depth ------------- ------- --------- \ ,� PACKAGE TREATMENT [ 7 SEPTIC TANK:[ ] Size------------------ ----------------- - y� -------------•- E Material- ----------- -------- No. Compartments Capacity ----- ----- -- - Type ------------- Pro Line --------------------- Distance `to nearest: Well ------------------------------------ - Foundation ----- ----------- - p• [ j --------- Length of each line------ < — =~ —Total-Length ----------- -----•----- LEACHING LINE No. of Lihes ------- ------------ -----•-De th Filter Material ------------ -------------------•---------- D' Box ------ ---- Type Filter Material P1. _..� ` Property Line ----------------- -� _ Foundation ------------------------ .._:.;_ Distance to-nearest: WeII --------------------- - I Rock Filled Yes ❑ No ❑i ,., "I, Number- ---------------------------- I SEEPAGE PIT [ ] Depth _ E erg_"- --•_ w ; ------------------- �~ Water Table Depth ------------ " -------Rock Size ------------------------ ~ ----• Foundation -------------------- Prop. tine Distance to nearest: Well ------------------------ ----- - --- ----- Date ----•-----------------------------1 REPAIR/ADDITION(Prev. Sanitation-Permit -------- -------- r - Septic Tank (Specify Requirements) --------------------------- v - ------------------- l/ `7____ Disposal Field (Specify Requirements) ---------- - � - __--s______________------------ _________ 1 ---------- ----------------------------- i ---------------- -----:-------- - (Draw-----sting and required ' ; ---------------------------" addition on reverse side) rk ill be done in accordance-with San Joaquin I hereby certify that I have prepared this application and that the wow County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Coca) Health District. Home owner or icen- sed agents signature certifies the following: arson in such manner "I certify that in the performance of the work for which this permit is issued, I shall not employ any p as to bac e s 'eci<to orkman's a do law f California." Owner Signed --------- - - --------------------------------- ____ ______ _ ---- ------ ------------------ ---- -- Title --- ------ ---- ------ ----- - - w -- �, By � Slf other than owner) _ FOL-DEPARTMENT USE ONLY DATE _-e _. --?--7�----------- 'j- APPLICATION ACCEPTED BY 4 DATE --------=f=% f BUILDING PERMIT ISSUED ----------------------- - --------------------------------- ------ ------------- - COMMENTS - ----------------------------------------------------------------------- ----------------- -------- '------.--------------------------------------------- --- ---- -- r _ --- -..Date ----- -------� �`_: Final lnspection,by: - {- '" z SAN JOAQUIN LOCI,11 HEALTH DISTRICT, E. H. 9 1-'68 Rev. 5M