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FOR OFFICE USEwe APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. -------------------- - - -------------------------------- This Permit Expires 1 Year From Date Issued Date Issued _!._�Z "7-L Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein i described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: , JOB ADDRESS/LOCATION .moc��}i,2_0_��--- ---� ------/!�nlf�---�C--------------------------------.------CENSUS TRACT --�--`-��------ Owner's Name . 9 y if�!"'l i &• � �---- ---------- Phone Address ----------- = --------- soy U -------------- . City _ ,H4i' ----------------------------------------------- Contractor's --•----------------------------------- ------Contractor's Name -----a�,-o-_----- ------ ------------ �--------------------------Licenser# ------- ----------- Phone ---------------------------•-- Installation will serve. Residence Apartme�n't House❑.Commercial :❑Trailer Court ;❑ Motel-O-Other _t i-----`----------- $ _ l Number of livingunits:__ Nber_of bedrooms _ -- Garbage Grinder _____t------ Lot Size ____ Water Supply: Publics sstem and name --�\�----------� -----------�-- ------�---------- N------------------------------------Private PP y• Y Character of soil to a depth of 3 feet: Sand Silt ClayPeat Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Ma#erial _____________ If'yMtYP s; e ----------------------------# �a ab (Plot plan, showing size oi, lot, location of system in relation to wells,,,+buildings, etc" must be placed on reverse side.) NEW INSTALLATION: {o septic tank or seepage pit permtted if public\,sewer is availdble within 204 feet,j PACKAGE TREATIMENtf SEPTIC TANK $ ej �'� .�f__ --------\\_ Liquid Depth __._ __________________ pan' Y n IType 1`C'_ _s_- Matenq),-- -n -- No Compartments -_" -•............. `� Ca acct Cl is ce to earest. Well ________�-----------------------Fou-ndation __-/_d___.______-- Prop. Line ___�_�...__........ ,_� t �f w � l5 R' �• LEACHING LINE [ 5 of Lines _____-3___f ------ Length/of�each line...... Total Length � ____ ______ -17' Box __ti! _ _ T e4ilter Material 1.�---Rkc`,_De Filter Material ---------------------------------------_____ P ., ✓ �- ------ Property Line _._ _- _... bistance tonearest: Well ______________________��Foundation _'�.--/�____ __ � _.___._._. SEEPAGE PIT [i] - Depth -_ ______ Diameter ______________ Number ------\\ ------ Rock Filled Yes ❑ No i❑ - Water pth l '` ------------------------------------------Rock S z ----------------------------- Distance te o nearest-. Well�------------------------�-\---------Foundation -------------------- Prop. Line ---------------------- r ( r j REPAIR/ADDITION Prev. Sanitation Permit# ------------- ----------------------W__-- Date ----------------------------------- SepticTank (Specify R quirejnentsj ------ --------------- ----------------------t�----------------------------------------------------------•..------- ------------------- -� I 1 Disposal Field (Specify Requirements) ---i------------------ ---------- �-------------------------------------------------------------------------------------- - I -------------� ------------- -.- - - ------- - _ --- ----- ---------------------------------'------------------------`-----------`- ---------------=--'---`--'__"__'-------------•----------- - ----------------------------------------- (Draw existing and required addition on revel'e;side)` I hereby certify that .14have 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�peHormance_of_the work for which this permit is issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of C:lifornia." Signed - !/9 � ------ a Owner BY /10 - ---- ------- --------------------------------------------- Title ------- �•(If of r) FOR DEPARTMENT USE 6NLYj,— r APPLICATION ACCEPTED BY -----F -C ___ r --� -----------------=- ------------------ --- -- ------ ---- ----------. DATE ---�- -��-�--�-�. BUILDING PERMIT ISSUED ------------- i----- - -------------- - --------------- -----DATE .------ -------------------------- - -- ------------------------------- - - ADDITIONAL COMMENTS ------------------------------------------ ------ ----------------------------------------- ------------------------------------ ----------- -------------------- - - ----------------------------- ------------ ------------ - ' ----- -- -- --------------- - ------ ---- ------ ----------- - ---------------------- ------ ? --- - - -------- Final Ins : _ r---------------------------------Date -- l SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M