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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 7 �_� � - ` ,� Permit No. ... ...... _..�---- • � ................. (Complete(Complete in Triplicate) -:.. ., p Date issued 1 ... � This Permit I~x ires !I Year From date issued { ................................. f work lth rict Application is hereby made to the San Joaq liancec wi heaCou ny t0 d narnce No. 549 and existing Rulest alnd hRegutat an$rein described. This application is. made in comp (fin D QYQ CENSUS TRACT JOB ADDRESS/LOCA ON • ...Phan® .............. Owner's Name _.. . dG�•..-�1-'� City ......................................................... ............. Address ... ' •........License �'Z'Z..`�5/.�a......... Phone _��.�.� � . .-•-- Contractor's Name -._ .�.� Installation will serve: Residence Apartment House i:] Commercial O railer Court motel ❑Other ----+ ------..:.� �.�....... 1. 9 - tot Size .... C,�L -- .. Number of living units:__._, ' Number of bedrooms ___ .....--Garbage Grinder J :. I Private .. Water Su I �Publid System and name -_. ...... ................. L Character of.soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam C ay odm ❑ i I " "' �" Adobe Fill Material ............ If yes,type �_ . ;_.,. .Hardpan-j] ❑ ..i, v.. I _ (Plot plan, showing size of lot, location of system in relation to waits, .buildings, etc. must be placed on reverse slde.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is avaitable'with§n 200 feet,) O I �a = _�/�"Llquid Depth ..... PACKAGE TREATMENT ( ] SEPTICTANKI I Size._.. -•------..... -. Type -------------• ----- Material---------------------- No. Compartments •- jCapacityt_---- - YP 4�. . . • Distarice� to nearest: Well _L�?�U-------------------••---•Founds#ion .,�d--•---..... _ . Prop. Line .�Q_......._.....- "_.� .. Tofal"`-Length .� .�....... oZ . Len th of each lin .._.. ................ LEACHING LINE [ j No. of Lines -----------------•.•--- 9 / ,� ,. , 'D' Box ..__ '.---- yp Filter Material _6....__ �. S Depth .Filter Materlal�":� _.....---• ................. yy T e Fitt ••••'-�� _ Foundation ..�...el„r--•• Property Line .��............... Distance to nedrest: Well' 1 ----- _.•-.- De Depth �---------- Diam.ter :X. Number ...._. .............!. Rock Filled Yes (� No (] SEEPAGE PIT ( ) p i f Water Table Depth - .............Rock Size .../4�• Distance to nearest Welt:. _...`.Foundation ad ......... Prop. Line . Q••-• Date � REPAIR/ADDITION(Prev. Sanitation Permit�# '- t -- j . !° Septic Tank (Specify Requirement `'s) ..-=--- -- • •• F _..- f Disposal Field (Specify Requirements)` ` ---------------- il -------- --- ; (Draw efisting and required addition on reverse side) f I hereby certify that 1 have prepared this application.and'th of the work will be done In accordance with San Joaquin County Ordinances, State Laws;and Mules and Regulatioiis'of the San Joaquin Local Health-District. Home owner or Iltett- sed agents signature certifies the following: ' arson in such manner "I certify that in the performance of the work for"w9'1ch this permit is issued, I shall not employ any p as to become subject to Workman's Compensation,laws of California." Signed •- ----------- ------------ ------------- BY t l r ----------------- i Y -<_-- � 1 i f.� (I other t n owner)-'- �' t n r 'r4. V, F' R flEPARTMENT USE ONLY- APPi iCAT10N ACCEPTED-6 _:° ._ :_ - ---•- DATE >:--��j.•=- :._ y ...DATE .-: BUILDING PERMIT ISSUED ----- ------------------------------------ --------- ADDITIONALCOMMENTS ---_---------••-------------- -•-----_---------------•----------------- ................ ....---.... ----- ------------------•-•.......... . ........................................... ............................ _..................................... - :........................ Date _.•-/.�:.� .......------....... Final Inspection b ---- �--. ;.....:....:......-.__...... EH 13 2L 1-68 Rev. 5, SAN J QUIN LOCAL HEALTH DISTRICT 8/71 .3M 4