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FOR OFFICE USE: 6 } APPLICATION FOR SANITATION PERMIT Permit_ No. ..�s•••-7•••-•• 11 (Complete in Triplicate) .......................... ............... Date issued .....:._............ = This Permit Expires 7 Year from Data Issued + ........................... the work ein ealth r'mit to cons Application is hereby made to the San Joaquin ian eLocal witlh CounDistrict 0 dnan a No. 549 and ex sti g Rules tand Regulations: described. This application is made I''in comp! ''e1 1 2 f f ..... .�........................• CENSUS TRACT #013 ADDRESS/LOC ION . ... _ .;.. .-�• �--.�. '_'"�, '• - ........Phone ...................... . ....._.. ' Owner's Name _ .. . ... �__..... _ -- ._ .............:................... 's Address _.._.._14W..0.1 �... .. Cit ynse # .,7-i • Phone . :•.................. :... 1 Lice _. ......... Contractor's Name ._.-_.- --'r' <s..-r�-•.-r. Q`._'.'_...__�._..'_:_.... ... I Commercial❑Trailer Court �] installation will serve: Residence ❑Apartment House Motel C]Other '�• ' '� .......... I Number of living units...:.__ Number of bedrooms ... .- Garbage.Grinder .__-__---_ Lot Size ............... .... .•- I Private Public System and name --------------- --- --•----•--•-....---•----••-- • ... :... Water Supply: y 't � Peat Sand Laam ❑ Clay Loam [3f Character of soil to a depth of 3 feet: Sand❑ Silr❑ Clay ❑ ❑ Hardpan C] Adobe aterial Fill M _....-----.. if yes,type ...................:..... � + buildings, etc. must be placed on reverse side.} (plot plan, showing size of lot, location of system in relation to wells, NEW INSTALLATION: (No septic tank or seepage pit permitted if public ,) sewer is available within 200 feet ' Y, k •- Size... ..... Liquid Depth I PACKAGE TREATMENT [ ] SEPTIC TANK} ] -•-•-•.................... ......... ... a—Compartments ...:.......... .. _ . Y i - Capacity'! _. ....... Type .....-----••------• . Material-._...::_:::"""r--- N r - ...----- Prap. Line : .................... • Well .......Foundation .....--_.--•-- j1 Distance to nearest: -•-�••-----••--•---" LV I ........................... 6n - . Total Length ' Length of each line..---••------------......... g LEACHING LINE [ l No. of Lines ......-----••••-•__.... �x ...De Depth Filter Mater#al ...........................:............:... p I 'D' Box Type Filter Material ....:......... •. P i < Prop" Line ..... I Distance to nearest: Well ........:.: .............. Foundation ..._......-----••-•-- -• P Y Depth Diameter ................ Number ..._........................ Rock Filled Yes ❑ No l❑� SEEPAGE PIT [ l P ...._..I.........__. __.. —--- --.._.Rock Size 'P Line Water,Table.-Depth ..........................•--••--••........... _-•..__ - - - . Foundation ..... rap. •------- •---- Distance to nearest: Well ....................................-._. ----••----••... Date ....................... REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ ..........:) . ..............•--- Septic Tank (Specify Requirements) _..-----... ............. .............. -- ............................. Disposal Field (Specify Requirements' .....A-••• .. .............. lI .............. ........ --•-..._...---•••--------------•-------- . ---•--- - ----�"----'- •..._....---•--......_I.--•-- ! (Draw existing and required addition on reverse side[ ' rk will be done 1 hereby certify that I have prepared this application and that the woIaccordance with San Joaquin t 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: k for which this per is issued, 1 shall not employ any person in such manner, i "I certify that in the performance of the wor as to become subject to Workrnan's Compensation laws of California," ` Signed --•----•-- ... . Owner ----- -:.. Title (If other than owner) FOR DEPARTMENT USE ONLY CEPTED BY APPLICATION AC . .......................... DATE ... .................. BUILDING PERMIT ISSUED ..................... .... ..................................._.............__......--•........•- ADDITiONAL COMMENTS ...............•---...---•- .._............. .... ------------••-••----••-• .....-- --•---........ _ Date .......... ................................... ......... ......_ .......... ......._....._ ,.r 1 Final inspection by.. .............•--- ........................ E. C . SAN ,10AQUIN LOCAL HEALTH DISTRICT 7/72 3 M