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rvrc UttICE USE: "!*. --^, •�,..�•; — . ................ ------------- •------- APPLICATION FOR SANITATION PERMIT ........__.. {Complete in o. -- Triplicate) Permit N �S ------------------- -----I......_._._..... ...... -• This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and Instal! the work h ' i e described. This ap licotion is made "n compliance with County Ordinance No: 549 and existing Rules and Regulationsre n JOB ADDRESS/LOCATI N � §� r� ' ...... CENSUS TRA 7- `t CE CT Owner's Name ...__. `�`-_.. . �•-v,S• Address _ + ' 2.6.................... .--_-.... I—..................... ..........Pho a ....... 7 - - -- ---••- F Contractor's Name .-- -.......... ..--•-�`�-Lr_...._ -------License Installation will se .. Phone ............. . ... . rve: Residence Q Apartment House C] Commercial QTrailer Court fl II, r Motel ElOther....... . . . --•-------•--••- Number of living units:___ :_.Number-of•bedrooms .. I k -Garbage Grinder ............ Lot Size .....-1 :.��-�-�e::................. Water Supply: Public System and name -----• :................... e ,t0 ..._...._-.:_ Pear❑ ` Private Character of soil to a depth of 3 feet: ' Sand�• Silt Clay []' Sandy Loam ❑ Clay Loom 0 /' � Hardpan � p n 0 . Adobe❑ Fill Material ............ If yes,type N ............... ............ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be plated on reverse side. NEW INSTALLATION: I�* (No septic tank or seepage pit permitted if public sewer.is available within 200 feet;} fa PACKAGE TREATMENT _[..j SEPTIC TANKr�7 J Size....... ..1,efC �� Liquid Depth Capacity ._ ? -'� -- Type ---� w`�.. Material_...._....... No. Compartments Foundation Distance. to nearest�le#I :._.. . `� ation . ....- Prop. Line LEACHING LINE ••-------•--•--.. [ No. of lines ..._ Length of each line:. . Total Length ...40K. ' 'D• Box .._ Type Filter Material 44.De th Filter Material 111V Distance to nearest: Well _---------••--------,--- Foundation ...... .. .............. ........... ~ Property Line .. SEEPAGE PIT [ ] `bepth - ......................� - Diameter _- .Number ............. .. .......:..: Rock Filled Yes No C] Water Table Depth ---•-Rock Size ...... Distance to nearest: Well ...................--__ -. Foundation .......... Prop. Line ................ REPAIR/ADDITION(Prev. Sanitation Permit;# ............................................--------------------- Date ......------ Septic Tank (Specify Requirements) ...:...........•-- •--•-•--..._..•-- Disposal Field (Specify Requirements) ..-----_..__ .-46 .............. ----.---••-----• ......... ............ ..-- �' .__.. .. -------------------------------•-.. __.._...--- --------•-----••-.. . ........... -------------------- _11----- -•-- ----•---•• - - (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.'LaJvs, and Rules and Regulations of the Son Joaquin Local Health;District. Home owner or licen- sed agents sign btu re.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 . beco sublect.to Workman's Comp ation laws of California." Signed - -:_. y�-/� . Owner BY .----- -•-- --- - ---- Ilf -----..__- Title . other than owner) ............................... /"?OR DEI ARTMENY USE ONLY APPLICATION .ACCEPTED BY _ DAT 14 �5 BUILDING PERMIT ISSUED - --------------------------------------- --------------------------------------------- ......DATA 17 ................... ADDITIONAL COMMENTS __.-----_-- - ----- - ------------- ------- -------- ------•-------. .._.. - -----...........- ............. --•------- -------- ---------- -------- ........................ ----.-•--------------- --•- ...._..... --....----- ---•---- --....._.__......... -" -- - _ Final Inspection by- ------------- - - -----------------------------------------DISTRICT 8/74 3M