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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ��_ic�9'4z Permit No. --------------------- - --------------- Issued (Complete in Triplicate) .......... --------------------------------------------- _ This Permit Expires 1 Year From Date issued Date _ Application is hereby made to the Son Joaquin Local Health District for a per to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: - - - - ------ -- --- CENSUS TRACT -------------------------- JOB ADDRESS/LOCATI - ------ -- ----- ' - -- -fi -- - / �/ . P-�� -----------------Phone f� = - -- Owner's Name ----- ------- --------- -- - -- ------ -------- Address ----- -- ---- / +ty C Contractor's Na -- f.p�License # Phone . Installation will serve: �Residenc Apartment House❑ Commercial []Trailer Court ',❑ Motel ❑ Other --------------- --------------------------- �• Garbage Grinder tot Size Number of living units:---- -- Number of b msa.+_- /y ----f l�oj Private ❑. �� ) ❑ Water Supply: Public System and name ... __ .__ i / �E/ ilfi Cla Peat Sandy Loam -❑ ClayLoam Character of soil to a depth of 3 feet; Sand❑ ❑ Y ❑ ❑ .. ' If yes,type ---------------------- - Hardpan ❑ Adobe' Fill Material .___.___.. buildings, etc. must be placed on reverse side.) [Pl'ot plan, showing size of lot, location of system in relation to wells, buil NEW INSTALLATION: (No septic.tank or seepage pit permitted if public sewer is available within 200 feet,) rU PACKAGE TREATMENT [ ] SEPTIC TANK[ ] Size----------------------°------------.---- - Liquid Depth _.------------------, --. Material-__-.F..... ........ No. Compartments ------ -------- Capacity ------ Type Distance t6..nearest: .Well ------------------------------------Foundation ---------------------- Prop. Line -------•---P--------- 1 �, t - t LEACHING LINE [ ] No.�of Lines ----------------------- h o_f'each .line-----�----- -------- ------ Total Length -------------------•-------- D' Box .___.� �- T e Filter Maters t _ er�gt i � ., t t.al-•--,-�'='�-----------Depth Filter Material ----- --------------------------------•---- YP 1. .. Foundation Property Line --------------- �-�Distance to nearest: Well ..._-_-. k-------- - ---- -------- --------- € I �' Number --------.-- Rock Filled Yes ❑ No SEEPAGE PIT [ ] Depth Diameter ---=------------ --- - i Water Table Depth Rock Size ----------------------- ----------------------------------------- i --------------------Foundation - . Prop. Line -------- ---------- - ----------------- Distance to nearest: Wet .................... - I ------- ------- ------- Date - ------ ----------------------- REPAIR/ADDITION(Prev. Sanitation Fermi -------- ----- Septic Tank Specify Re uirements) _t_.- - --- L' a� Ott Disposal Fiel fy Requiremenfis) -.--- -------------------= ----- - ---- ------ Y` -- - ------------------------------- -- -- - ------- - - (Draw existing and required addition on reverse side) 1 hereby certify that 1 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 i the performance of the work for which this ermit is issued, I shall not employ any person in such manner as to bco u je to W k Co sat' r� s o California." Signed - _.� Owner I t 1 B - ------- Title --- ------- -------------- -------- ---------------------------- l y (if other than owner) ARTMENT USE ONLY . - --- ---- ------------------ ------ --------- DATE - '- ^� APPLICATION ACCEPTED BY __-- t .�- - DATE ...---- ------ ------- PERMIT ISSUED `. =-- ADDITIONAL COMMENTS ------- - ---- --- - ----- ----------------- - ---------------------------------- ----------------------------------------------------- - ----------------------- --------- ------------ --- ------- ---------------------- - ---------------- --- - - - -------- _ Date ----- -- -- ------- Final Ins "action b -- --- --- ------ ----- ---------- -------- -- - S IN LOCAL HEALTH DISTRICT E. H. 9 1 '6 R Rev;