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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ---- ---,;�----w-__ -------------------------------- Permit No: {Complete in Trip icate ----------------------- a Date Issued __. This Permit Expires 1 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 described. This application is made in tom liance w' n4tO rd 549 and existing Ives a d Regulations: - described. /� jk� �j G i I G? � 1 e- JOB ADDRESS/LO T10a ` CEN US 7RAT r r Phone Owner's Name ..___ Yrs ::� ---------------------------------------- ---- yy_ Address --------------- ------ -- ,./--^�-------- ----------------.__. City -5 -------------------- ------------------------- -----••------ �� `�? -----------------------------------License #�7�,�-3 5----- Phone ��5�=�--/'-� Contractor's Name __.._. _-a__ _ ____________�'__----____-- Installation will serve: Residence partment House❑ Commercial ❑Trailer Court ',❑ Motel ❑ Other -------------`------------------------------- _ Number of living units:------- ___ Number oft/"-- I drooms ---X-----Garbage Grinder �/C'S-- Lot Size _ Q-X-- - --------------------- I r� -- -------Private ❑ Water Supply:,.Public System and name --------= Peat❑ Sand Loam Clay,Loam:❑ Character of soil to a depth of 3 feet. Sand'❑ Silt❑ Clay ❑ Y ❑ Y .. k Hardpan ❑ Adpbe:E7 Fill Material _. - if Yes, type } r buildings, etc. must be placed on reverse side.) (Plot plan, showing size of lot, location of system in relation to wells, \ 'I NEW INSTALLATION: (No septictankor seepage pit permitted if public sewer is avoilable.within 200 feet /7�-- PACKAGE TREATMENT [ a SEPTIC TANKX 5i -------T ---------- Liquid Depth -.�----- Capacity ?p--------- Type `-'" Material_ '`�'L` Z` o. Compartments � •.--.=-.-- ' Distance to nearest: Well ____------------------_--=- -------Foundation ------ ------------ Prop. Line _ ------------- LEACHING LINE No. of Lines ------------------- Length of each-line. }-- -�- ------ Total Length 1 --------------------- D' Box _ _r_5�_s__- Type Filter Material C k--_____Depth Filter Material __�i1 -------------------------- Foundation Property Line t �_-------- Distance o nearest: Well --- -------- - ----- ------------ p � �L/�l s 13 3 - m SEEPAGE PIT ``�, Depth __c My -= Diameter 12 Number ___.,.___- - ------------ Rock Filled Yes No I Water Table Depth ------ `/G' ---------------------- --- Rack Size_//---- �- Distance to nearest: Well-----------------------------------------Foundation _z`- ------•---- Prop. Line 1�-_ _---:_.-..._ REPAIR/ADDITION(Prev. Sanitation Permit# -------- ----------------------------------- Date --------------------------•-------) ' Septic Tank (Specify Requirements) ------------------------------ F DisposalField (Specify Requirements) -----------r----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ' t --------------------------------------------------- ' --------- ---------------'----------------------------------------------------------------------------------------------------------------------------------------- --------- (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 Laws, and 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 j as to become subject to Workman's Compensation laws of California." v ' Owner Signed ------------------ --------------;w�n )------------------------------------`---- ,/ -- Title _C2 C� -K,— --------------------- (I.f-other than FOR .DEPARTMENT USE ONLY ' APPLICATION ACCEPTED BY --- ---------------------- - DATE ---- = �� BUILDING PERMIT, ISSUED -------------------------------- ------------- DATE ADDITIONALCOMMENTS ---------`'-------------------- ------- --------------------•----------------------------------------------------------------------------------- ----------------------------------------------------------- --------------------------------------------------------------------------- r .------ - ---11## - - - - --------------------------------------------- - - - ------ - - - ---------------------- ----'---------------------- -------------- --- -----------------Final Inspection b �� Date SAN JOAQUIN LOC L HEALTH DISTRICT CA��//�j,. ' l E. H. 9 1-'68 Rev. 5M.