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FOR oFElcE USE: s -APPLICATION FOR SANITATION PERMIT �� Permit No: -- ----------- -------------------------- ¢ (Complete in Triplicate) - Date Issued -�,,'-/__n This Permit Expires 1 Year From Date Issued i cl Application is hereby made to the San 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 Reggulations: 1[tTC14 ---•---------------CENSUS TRACT ----Y� ----------- JOB ADDRESS/LOCATION : ©b_ _ (v/�f O_ !___,' -------------------- _ Phone Owne'r's Name � j �a1. /21 -- � Address --- f-yU---f/-PPSVA1 --- - G ------------------------- ------------ me '� 5 - r -------------------------------------------------- -----License# %11 /'T �-�%�--------=----�-------------..._ ,_ . City _�.N--fj�1_�� Contractor's Na J - _ - �____ Phone �-�-- Instailation will served'"` Residence ®-Apartment House❑ Commercial ❑Trailer Court! E] Number of living units:___.I------ NumberMotel of �drooms .__________ Garbage Grinder -IVO- - _-_ Lot Size .j1—__X_f�- -------------••--- 9 Water Supply: Public System and name ---------------------------------- Private Character of soil to a depth of 3 feet: Sand'El Silt❑ Clay ❑ Peat❑ Sandy Loam Clay Loam :❑ Hardpan ❑ Adobe F-1FillMaterial __r v4 - if yds, type ---------------------------- __(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be'--laced on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) SEPTIC TANK Size---�_ Y_S,-"--T� l------------------- Liquid Depth ---------------= PACKAGE TREATMENT { ] [� Capacity 1,)aD------- Type 29--c __ Material, D/r�� 1. - No.' Compartments ,.------- - ,. � F Foundation _. 0 Prop. Line ._ ------=- Distance to nearest: Well ---- --- -- .�-------- ' u LEACHING LINE No. of Lines -----/---------------- Length of each line----- Total Length _- -.r--- 'D' Box ---- Type Filter Material __A--------------Depth Filter Material ___ 9---------------------------------- I Distance to nearest: Well ---L�—t`�__l-------- Foundation _._/D___--- Property Line..__S___________________ SEEPAGE PIT Depth -_-----------, Diameter __ ___. Number __________________ Rock Filled Yes ®— No :0 Water Table Depth ------------------------------------------------Rock Size ---------- "r.. Distance to nearest: Well --- lO_f?-__�--------------- ----Foundation ---ltf.1-- ---- Prop. Line _. _---_--•--•-- ; REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------- ----------) Septic Tank (Specify Requirements) ---- ----- -- -` ----------------- t ------- -- �M Disposal Field (Specify Requirements) -- rJ- ----- ii?e h1�V T n�K---- Cf��tRDEFt�R- ------------------------ __.- --------_ r (Draw existing and required addition on reverse side) I hereby certify that I have•prepared this application and that the work will he done inl accordance with San Joaquin e 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 as to becom sub jec t Wor man's Compensation laws of California." it ---------------- OwnerSigned --------------- BY i L ----- Title --------------------------------i`- -------------- ------------------- ------------------------------- (If other than owner) . . .", :... FOR DEPARTMENT USE ONLY , APPLICATION ACCEPTED BY --------- ----------------------------------- ----------------------------- DATE ----- ------------ BUILDING PERMIT ISSUED ------------------- -------DATE ------------------ T -- ADDITIONAL COMMENTS _INS--y------ ----------- ---- -------------- ---------- ------------------------------------------------------------------------- --------------- - ----- ------ - ----- ---- ---------------------------- ----------------------------- ------ -- ------- ----- -- - -- ------ --------------------- ------------------------------------- - Date Final {nspecti ---------------------------------- �— SAN JOAQUIN LOCAL HEALTH DISTRICT II E. H. 9 1-'68 Rev. 5M. e R