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FOR-OFFIC&USE: y APPLICATION FOR SANITATION PERMIT i Permit No. --�------ap --- (Compl a in Triplicate) Date Issued -�-a- -"--70 This Permit Expires 1 Year From Date Issue ; Application is hereby e the�Sdn oaqui�ocal �E. District or a 'permit to construct and install the work herein rdinance No. 549 and exJENgUS u1e and R gulations:. described. This a cation is made in compliance with County5 ; I ~0. P ]Zk TRACT -------------------------- JOB DDRE S/LOCATION I --- - --------I------P one ------------- -------------------- Phone -- Owner's Na t..;, Ci#y --------------------------------- - -------- - Address ----=_ Phone ----------- Contractor's Name ------------------------ �- ------ ----- - . --License --------- -------------- Residence ['Apartment House❑ Commercial .❑Trailer Court ❑ Installation will serve: Motel ❑Other ------------------------------------ ---- Number of living units:..'-------- Number of bedrooms - ----- Gcrb=_ r -- �---- ' Lot Size ------- - - i :� r ------------ ----Private P-,-- Water Supply: Public System and name ------------------------------------ ----- { Silt❑ Clay ❑ � Peat F1 Sandy Loam � Clay Loam 0Character of soil to a depth of 3:feet: Sand'[], _- Hardpan ❑ Adobe'❑ Fill Material ------.--.-- if yes,type --�------ t Ian showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) (plot p available within 200 feet,) ermined '9f ubiic sewe r is P P NEW INSTALLATION: {No septic tank or seepa e +t [ �_ Li uid Depth -..- p P 9 P . E ' PACKAGE TREATMENT [ SEPTIC TANK' Size--lz =------ -Compartments i Material-----� --- Na. Compartments ---------- •--•---- �7 Capacity ZYP6M - i . r f . y. P Y i �, � O--------- Pro Line _ _ --Foundation -- ---------- p• . r - Distance to nearest: Well -- - -- - --- - 2 fl .1 k �"� I Length of each line---------<i-D-1--- --- Total Length ---- ----- LEACHING LINE [le}r No. of Lines A -De Depth Filter Material ------------------------------�-f----•----- V r I 'D' Box ------------ Type Filter Material --------------- P nl `7 5�-•O9 ---- �I_a--+---- Property Line. ---�-�------•------ __-_�__- Foundation Distance to nearest, Well -- ---:- ---- No .,O k SEEPAGE PIT [ ] Depth. .-- -- ----- Diameter - -=---- Number ------------ Rock`Filled Yes ❑ '= Rock Size ------------- Water Table Depth ------------------------ - t , Foundation -------------------- Prop. Line ------ ------ ----•- Distance to nearest: Well ----------------------------------------- ' i. REPate -------------- •---------------} AIR./ADDITION(Prev.(Frau. Sanitation Permit _ _ ------ ------------------------- }. Septic Tank {Specify Requirements) --- ------= --=------- -`--- ---- -�--- � --- - ------------ r i -------aro- -- - -- - --- Disposal Field (Specify Requirements) -- s�- -- ew-►• -- (Draw existing and required addition on reverse side) I hereby certify that F.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 Ae San Joaquin Local Health District. Home owner or liven- sed agents signature certifies the following: arson in 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 subject to Workman's Com ensati.on laws of California." Owner Signed -. - --- ---------- ------- --------------- Title --- --- - ---------------- ---------------- (If other than ner) by" RDEPARTM T USE ONLY f - --- -�-- --- -- -- --- --- ----- � DATE ---- - --�-�-------------- APPLICATION ACCEPTED BY -- ----- -- a ---------------------- BUILDING PERMIT ISSUED ---------------'----.-------------- ----------- ----------------= ---- - -. - DAT - --------------------------- ADD TIONAL CO MENTS _, = o --�-------------------------------------- =76--- ---- ---------- --------- --- ( 1'+giujl - ---- - --- to -- 70 Final Inspection --------- F-----�---�---- ---- -- - -- --��,w �---. �---- ----a --- D o �} U SAN JOAQUIN LOCAL HEALTH FDISTRiCT E. H. 9 1-'68 Rev. 5M