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_ R OFFICE USE: APPLICATION FOR SANITAT80N PERMIT 7_ 3 Permit No. - - -- -- ---��- -�-- - (Complete in Triplicate) � V —6------- ----- ----- -- j - � Date Issued --- ----- --------- ----- --- --= --- --------------------------------------- _ This Permit Expires 1 Year From bate issued is ------- Application the is hereby made to the San Joaquin local Health District Warn a permit to 9 andtract existing Rulesand andRegulationwork herein s- ------------------ : described. This application is made in compliance withCounty - 1ct t�+ l -lN- .....CENSUS TRACT -- JOB ADDRESS/LOCATION .------- -1 -------------Phone ---------------------------"-------- �------------- ---- ---------------•------ Owner's Name ------------------S-O-/O- --------�- Q-121 ------------------------------------ ------- City Address ---------------- --------------- - License # ----- art -- Phone ------------------ �r Contractor's Name ------ ----- - - - -- ---- -- - - ---- - - installation will serve: Residence N'Apartment House'❑ Commercial ❑Trader Co D - - --------------- �} Motel ❑Other ------------------------------------------- ----- ------- - -- -- __ cz e rrS� Number of living units:_-_-__�__.-- Number of bedrooms __ - ---Garbage Grinder _-- -- Lot Size - Private ❑° I Water Supply: Public System and name ------------------------------- CVay Loam :❑ --- '❑ Peat Y Character of soil to a depth of 3 feeSilt❑ Clay ❑ ❑t: SandSand Loam W' __ l#yes, type ---- ----------- --------- -4- Hardpan _.- .Adobe-C] - Fill Materia{ .......... f laced on reverse side.) (Plot plan, showing size of lot, location of system in relation to wells, buildings, tc: must be p NEW INSTALLATION: [No septic tank or seepage pit permitted if public sewer is available within 240 feet,} Size--------- ------------ Liquid Depth --------------------------- PACKAGE -------------- -----. i PACKAGE TREATMENT [ ] SEPTIC TANK�[ ] r � =' Capacity : Type - Material---------------- ----- No. Compartments --------- -- to nearest: Well ------------------------------------Foundation --- ----- --- ---- -- ------Foundation ---------------------- Prop. Line --------- - � - ---- ----- ------ Total length -- ------------•------------ No. of Lines ` r LE;/CHING LINE [ ] ---- ------ - - Length of eac � line -e Depth Filter Material ----------------- - ��---'--•'-'" 'D' Box -1---------- Type Filter Materia! ,---------- D P =---------- -- Foundation --------------- k Distance ito nearest: Well '--_--- --- 1 Rock Filled Yes No i0 Property1 ----- t --- - ---- -- -- Diamefier--- ------ ---------Number ---- --- -- ----- ----- - i SEEPAGE PIT [ ] Water T F able Depth Depth Rock Size ---- - x � -- Pro Line .-------`'----•-•------ Foundation -------------- p Distance to nearest: Well --------------------------------------� ! - Date ------------------1 D. ---- REPAIR/ADD{TION(Prev. Sanitation Permit =` I 1�` 1 -. -------------------------- ---- ---------------------- --------------------- Septic Tank (specify Requirements) ------ ----------------------------------- ' Disposal Field (Specify Requirements) _ -: b �---------- -- -- ----":-- --- �x!• --- ---------- !' - = rse side -------------------------------------- ------------------ - _ - - - ---- -- --- -- ------------ ----- - Home owner, pplication g q r' Health District. (Draw existin and re uired addition on reve i owneror licen- I hereby certify that I have prepared this aRegulations tof the•San Joaquin.Local H in accordance with neroraqum County Ordinances, State Laws, and Rules and sed agents signature certifies the following: "I certify that in the performance of the work For which this permit is issued, { shall not employ any person in such manner as to beco�'Ijr kman's Compensation laws of California." I Owner Signed - --------------I - --------------------------- --- ___ ---- ------- ----- ------- ----- Title ----- --- ------ ----- ---- - (lf other than owner) F DEP RTMENT USE ONLY H - DATEDATE ?a �----------- APPLICATION ACCEPTED BY _- ------ ------ ----------- '-------- ADDITIONAL MIT I SUED ......- --------------- ENTS --AW--- - -- ------------- 6UILDING PERMIT ---------------------------------------------------------------------- -)-----�-2- -Ii- -------------- - - ---- ----- --- ----- ----- ------- --------- Date = - X77----- --- - ---- &- --- Final Inspection by: --.--- 1 SAN JOAQUIN LOCAL HEALTH DISTRICT �i E. H. 9 1-'68 Rev. 5M