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_,FOR OFFICE USE: ' J, __. v APPLICATION FOR SANITATION.P,ERMtT � i'r "0. _._._ .. .Perm o. .......... -.. It N .� r2- ................................. .. lCotnplete in Tdpllcate) 7 n , ssu I -•-•--....---•.................................•-----.. - Phis.Permit Expires I Year Frani Date#sswod Date ! ed �'�`�.. Application is hereby made to the San.Joaquin Local Health District for a permit to canstr6cl and alnstall the work herein described. This applecation is made.irt compliance with°County,Ordinance No. 540'6 d-kisting-Rules.and Regulations: JOB ADDRESS/LOCATION .-.o?� :__./ ♦♦� ` •:./.1 . }Sfix .. ..! ........ ..f CENSUS TRACT .......... _........ Owner's N-ame A/1 ......:. - : -- .--,- c;.l. __...... .... "- - Pho.n..e............. ..` .`.`'... ....7..... ..........._.:. '�Address ..__.. City . ..........License .. PhoneContractor's Nome AV,. s .- f" Installation will serve: ResidencejgApartment House fl Commercial❑frailer Court Motel 0 Other ::.:. ............... Number of living units:.... Number. of bedrooms r-Garbage Grinder A149... Lot Size ... Water Supply: Public System and nariie .................... ..'------ ... r hate Character of sail to a depth of 3 feet: Sand❑ $il#❑ Clay 0 .-Peat❑ Sandy Loam 0 Clay Loam 1 ir::.Hardpan El Adobe 0 Fill Material :-:----..... If yes,type .' ........:.. ............ j (Plot plan, showing size of lot, 'locution of sysfem,ln relation to wells; buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank_or seepage pit permitted 'if public sewer is available within 200 feet,) C PACKAGE TREATMENTSEPTIC TANK r- [ ] ] Size-................................ •.,.._.:..... Liquid. Depth --••................. ...... � -- Capacity -� " -- ---.:_'- -------- - Type -•--•--------------- Material.-------------- No. Compartments ...............-•=--• ...... Distance.to nearest: Well ...............................--Founds#ion .--................... Prop. Line........................ , LEACHING LINE No. of Lines .... Total Length ' [ l __.__ Length of each line.--.--...........__ .............. {" 'D' Box Type Filter Material ..............................................--------• ....................Depth,.Filter Material Distance to nearest; Well ........ "Foundation ........ Property Line SEEPAGE PIT [ ! Depth .....;•------------- Diameter -- `.__...... Number ........ .................... Rock Filled Yes ❑ No �] d ° Water Table Depth :. kock Size Distdnes to nearest: Well ............Foundation .................. REPAIItjADDITION(Prev. Sanitation Permit�# ,. D to Sepc.:Tank (S act Requirements) -----.... �_-•-- l�� R.. ....C' .. - / ..; ' ,- fy Requirements)sal Field (Specir ---- -----------------••--- --------• ---------------------------- . -----•- -•-•--.-.... . „ (Draw existing and required addition on reverse side) - 11 hereby certify that I have prepared this application and that the work will be clone in accordance with Sin Joaquin County Ordinanos, State Laws, and Rules and Regulations of .the San Joaquin Local Heal&District. Rome owner or licen- sed agents signature certifies the following: "i certify that In the performance of the work"farwhich this permit is issued, 1 shall not employ any person In such manner,. .. as to become subject to Workman's Compensation laws of California." r4.:: Signed .. = --- -- -- •--•- ........ Owner By - ----- •--- --- -- ------ ---- --- --;-- •. ._.... Title ------------.....--------- Of other t o er) i! R PARTMENT USE ONLY APPLICATION ACCEPTED BY _. 7 DATE l -BUILDING PERMIT ISSUED.......................... - DATE - ' ADDITigqN.pC`COMMENTS_ _ __ _ irk.. ------•-------- -- ---.....__--------w----- ---- -... ----- ------'-•---. - .._--------------------- - -------------- ' 11 . -. ---------- - ;Fi l Inspection by: ...' j� •-----•••... ........... .•-Date s ._7 ... --... ..- ' �$ 24 1-68 Rev. 5m SAN .i0 QUIN LOCAL HEALTH DISTRICT $ T4 3M.