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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Triplicate) -------------------- Date Issued -- -.--71 --------------- ------ This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein # described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOC TION 1 '1V7-----F ------ ... L1rC a- --------------------------- ----CENSUS TRACT - `�J-� - .U_1-D- RVAA��------- r Phone. - --% A/ Owner's Name __. p •� ' -- Cit �_]_!'- � ---------------------- -------------------------- Address ------/�1-�-------�----.51�.I�`t��--------------------------- Y - -- Contractor's Name --------Q_I;�tll��,f--�- �-------- ---•- --- ----- ------- •- -------.License # ------------------------ Phone ------------------------------ Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court i❑ Motel ❑ Other ------------------------------------------- i Number of living units:--__l------- Number of bedrooms--------Garbage Grinder `----- -_-- Lot Size ---1 ____-- --------- Water Supply: Public System and name -------------------------- ------------------------------------------------------------ � ,.. - ,.-,.�----- 71 Character of soil to a depth of 3 feet: Sand'❑ Silt❑- Clay ❑ Peat[ISandy Loam Cay Loam Hardpan ❑ Adobe ❑ Fill Material ------------ if yes,type ---------------------------- (Plot plan, showing size f lot, location of system in �lation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit per if public sewer is available within 200 feet,)` PACKAGE TREATMENT [ ] SEPTIC TANK'( ] Size-------------------------------------- -------- Liquid Depth -------------------------- V - `-" Material---------- ------ No. Compartments acity T -------- ---Foundation -- ------------------- Prop. Line ---- -- =----------- �Dppance to nearest: W pe ____-"�---------------------•- Len'th of each line------------------ -- ------ Total Length -----------------------••- LEACHING LINE I ] ITNo. of Lines ----------------- ---- � g # i ------.De ----------------------- Depth Filter Material --------------------- 'D' Bax ____-------- Type Fi ter Materjal _____________ p i --__ Foundation ------------- ----- Distance to nearest: Well -..-___--___---_ _- ---- Property Line ;% - - Rock Filled Yes ❑ No 0 SEEPAGE PIT [ ] Depth -------------------- Di meter Number ---------- Table Depth ------ - Rock Size -------------------------------- Water Distance to nearest: W '`-'" ' Foundation ------------------ Prop. Line ---•-.-------•-•------ ` : Date ------------ ------1 REPAIR/ADDITION(Prev. Sanitation Permit .... T ------------� ------------- i Septic Tank {Specify Requirements) -------- ------ - - c -_ -4FA --- ---- ------------------------- -- ----------- p Field 1Specif Requirements) -�--- t 1 , - - -------- ---------- Dis osa Y QST --rte- s-t NI �; �__ .. . s � :_-------------- 7 -- -- ------ - --- �� --------------- ='-- ._ {Draw existing and required addit;ori on reverse side) Ti I hereby certify that 1 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 the San Joaquin Local Health District. Home owner or licen- sed*_ _ re certifies the following: ^, * r "I che, or once of the work for: this permit is issued, 1 shall not employ any person in 3such manner I as ect t° arkman Compensation' la s o a ornia." _ -.-__ SigOwner = ----- ------ --- ------- ---------------------------- -------------------------------- T{ other than owner)- _ �' FOR DEPARTMENT USE ONLY r a c ' DATE - ---7-`- _7-- ------------------ APPLICATION ACCEPTED BYt s BUILDING PERMIT ISSUED J---- ----------------------------------------------------------------------------------- ----- -------DATE f ;- - - i ADDITIONAL COMMENTS --j- - ---- - ---- ------------- ------------------------- ------ --------------- ----------- ----------- --------=- -----J--. -------- •-- --: - - -- --------------------------- --------------------------------- -7r- i�zN 17 -- - ------ ---- - ------------- ---- - ------------------------------ _ - ------- .-- _ .� to --- --------- --------•------ Date Fina! f - SAN JOAQUIN LOCAL HEALTH DISTRICT : r r_ u a 1-'AA RPv 5M ---