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FOR OFFICE USE: =i"APPLICATION FOR SANITATION PERMIT ^ a - Permit No. - - (Complete in Triplicate) ' -------- -; r r °._ b6te Issued -Y� _... __ This Permit Expires 1 Year From bale issued( Application is, hereby made to the+Son Joaquin Local Health District fora permit to`cons#�u'ct-and-'instaIf-the.. work herein described. This application is made in compliance with County Ordnance No. 549 and existing Rules and Regus lation 1 JOB ADDRESS/LO ATION --i_9_� �__S -- - CENSUS TRACT __ -�- � E 11j_ . _ ------------ j< J✓TT��,y- ------------ - Phone Owner's Name. - voo h�_-.....R_IPnN------- �_ _ _ ! _ --+�----- Address -._ 1 .. --• City ---------------------------------------- - ----------- - License --- Phone --------------------_------- r ----------Narme ,- f\l ; - - - ' Installation will serve:" :_ Residence Apartment House-E] Commercial :t Trailer Court ',❑ Motel ❑Other ---------- Number of living units:_--- ___ Number of bedrooms -~�--Garbage Grind r ____ Lot Size -- -- _ - Private Water Supply: Public Systerri and name --------------------------------------- -` - _ � Choracter of soil to a depth of 3 feet: Sand'❑ Silt❑ Clays .Peat Sandy Loam r� Clay Loarraw❑� - type == =) Hardpan ❑ Adobe ❑ Fil! Mbterial �-_ If yes,t i buildings, etc. must be placed on rek. verse side,) (Plot plan, showing size of lot, location of system in relation o ells, NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is_aVailable within 200 feet,) ` PACKAGE TREATMENT { SEPTIC TANK Size---- _ Liquid Depth:.,.,---------------- -- ---- Type - Material--� ----- No. CompartmeCa, nts. ] pacity ----.----. :- YP � . `tance "to` n: e, ----- --- ; � -------Fours at om`-_ --------- Prop. Line [ Drs of Lines jefith of each line------Total Length -------- -- ---------------- LEACHING LINE Nod _ 1 D'i Box -------- -\Typ47-Filter Mciterial ---_� p ter Maters u -------------------•-- - 'a r ------ Pro e�ty Line ------------------------ -- ` `. Distance to nearest: Well _ ________________ _ Foundation __ . SEEPAGE PIT [Jj Depth• s _--- --- D,�ameter ----_--- �Numbgr -- -.---- Rock Filled Yes ❑ No '� -----= ---- ------Rock Size ----------------------------- Water P T le Depth ---- �------------------ _", fi Dis`tanee; nearest: Well -r• -------------Foundation Prop. Line- --{ y I REPAIRfADDITION[Prey: Sanitat.iA Permit# ---- --------------------- ---------- Date-----. ---- --------- ------- } Septic Tank (Specif Requir tn its) -------------- 2- ; = = ,• Disposal Field [Specify Re -------A1_✓ '_--_ Q1S.----'---; _------.71�1 ._ 1C1� ---------------------� -- y ------------------------ 41 - ----------- ------ ---- � F --------" NS,------------ ----- ------------ --------- _ - I (draw existin and required addition---^- on on reverse side) I hereby certify that ,e prepared this application and that the work will be I vin accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin-Local He,lth 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 n otiem Joy any person in such manner as to beco a subject to Workman's Compensation taws of California." Signed ----- ------------------------- Owner as'�tti --- - -- ---- -------- Title --------- ----- --------- (If other than owner) FOR DEPARTMENT USE .ONLY APPLICATION ACCEPTED -,BY _-. -IE- �� ------------------ [DATE ----- .�'.��= AQDD ONALCOIMMENTS,__. -�'� # ; DPcT ___-- -- -- - ---- ------------ ---------------------------------------------------------- ------------------ ---- --------------------- - _ -------- ---------- -- ----- ---- ------- --- �� # 7 Final Inspection by: ----- ---------------- ----------- Date - ---------- ------- - ' SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1 '68 Rev. 5M -x