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FOR OFFICE YPE: T �AJPPI,ICATION FOR SANITATION PERMIT ��_ 7 �t .:; Permit No - --------------- ,per i 5 3`-(]-7---- ---�------ -- ------ -------- -,•---- - (Complete in Triplicate) Date Issued------------------------------------ - This Permit Expires 1 Year From Date Issued e work it to construct and in Application is hereby made lsomQde in compllianceLocal wiHh Counealth District Ordinafor n a Nom5.49 and existing Rules talnd hRegulat onsrein described. This applicationf c A { JOB ADDRESS/LO TION ._±- _ �--- CENSUS TRACT ---------------------• --- ---------------------- _ -1_�------ _ 4 Phone .FU47:- -ice Owner's Name _- � --_-_-- •_--_-- ffr/ ----------------------•. City _ - :---- --------------- ------------------------ Address ---- ---- -l--2--f�%� ---- - - --- - ----- --- - r ------- Phone __ 6f6o• m �— - Contractor's Name,,! --- -----+� ------.License # ----- - -.- - - installation will serve: Residence v;4partment House-[-] Commercial:❑Trailer Court E_ j Motel❑Other ------------------------------------------- l411-eNumber of living units:..__-_.-___ Number of bedrooms Garbage Grinder _.__.__-_.__ Lot Size - private Water Supply: Public System and name ----------------- --- - - �-- -.. - Character of soil to a depth of 3 feet. Sand'❑ Sit#❑ Clay ❑• Peat❑Sandy Loam ❑ Clay Loam If yes, e ---------------------------- Hardpan ❑ Adobe ❑ Fill Material ------------ ,typ , (Plot plan, showing size of lot, location of system in relation to' wells, buildings, etc. must be placed on reverse �side.) k NEW INSTALLATION: (No septic tank or seepage pit permitted if publicseweris available within 200 feet,) PACKAGE TREATMENT N' SEPTIC TANK -------------------- Siie --��_0 __ I Liquid Depth .-_��-•------•-- '( ] No. Compartments - _-- �.a-eMaterial_ -�- -•�-- p Capacity .r1_.Z B-rD->-- Type -f V Q._-.. Distance to nearest: Well ____��------ - ------Foundation --------- - Prop. Line --/470 0 . il, rrrr�� Total Lth ------ -•------ I - LEACHING LINE + No. of Lines _._RC1______________ Length f�ea line-----8 ,y .0. _-.Depth Filter Material _17-- ----------•-•---•----- ••--------- � 'D' Box .---I------- Type Filter Material - ------------- - �, Foundations^ -`-,Property Line '. Distance to nearest: Well :_ _ -- ° � _-__ Number ______--Z\ -------- Rock Filled.. Yes No G, k SEEPAGE PIT �(�' Depth _ 2XDiameter _ Water Table Depth __.___ p� �- - Rock Size _�` - •---- i -- r � °'Foundation ._ 1 Distance to nearest: Well ---I- 0-•- �p Prop. Line .. .-,-: REPAIR/ADDITION(Priv. Sanitation Permit# -----F=------------------ Date ------'"� i -------- --------) ! l i, ♦ 5 _ ______________________________________________ Septic Tank (Specify Requirements) __________ '------------------------- Disposal Field (Specify Requirements) -----------•---------------• ---------------- ------------------ ------------------------------:---------------- .,, _ --------------- -- ----------------- -------•- . -------------=------------------------- - - 1. . « ; -� -------------------------- ----------- (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 oftheSan Joaquin Local Health District. Home owner or licen- '"j sed agents signature certifies the following: " p person list such manner "I..Certify.that in the performance of the work for which this permit is issued, I shall not employ any p { as to become subi to Workman's Compensation laws of California." _ [ �Signedtz�F4.S �'------------- t Titled - ---------------- - --------- ---------------- (If other than owner) FOR PARTMENT US ONLY _ �S - APPLICATION ACCEPTED BY ------- --- --- ---------------------------- -------------------------------- -------- - ------------------ DATE - ---- ------------ DAT BUILDING PERMIT ISSUED ------------------------------------------------------------- -- ------ ADDITIONAL COMMENTS ---------------------- -----•-------------- ------------------ ------------------------------ ------------------------------- ' �_--------- ------------------------- - ------------- -- ---- --------- - -- -------- -------- -------- ------------------------- ---- Date - --- r Final Inspection b ......... ---- --------------------- - ------------------------------------------- SAN JOAOUIN L AL HEALTH DISTRICT �> E. H. 9 1-'68 Rev. 5M