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FOR OFFICE USE: APPLICATION FdR SANITATION PERMIT .............. ............................. . ..... (Complete In Triplicate) Permit No, --- ......................... ......... ............. ..................... --------- This permit Expires I Year From Dot*issued Date issued 72- Application is hereby made to the San Joaquin Local Health District for a permit to constru described. This application is made in compliance with County Ordinance. ... ct and install the work herein I No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATIO .71 0 CENSUS TRACT ........ Owner's Name .......... Address ... . .. .......----Ph one -------- City ... ..... ...... .......... ... Contractor's Name............. .. ... .... ..... ......... . .......................... . . . ....... .. . ... . .... ----- --- - ..............License # -19P.401... Phone Installation will serve, Residence 9 Apartment House C1 Commercial OTralleir Court ❑ Number of living units:..... I Motel El Other..... ..........................__...... I---- Number of bedrooms ----3_Gorbqge Grinder ---_------ Lot Size -------- W40ielSupply: Public System and name ........ ........... Ch6' ...........❑----------- ........... ---------------------------------_...Private IV of soil to a depth of 3 feelt.- Sanc!13 Silt[] Clay ea0 Sandy Loom 0 Clay Loom r 0 Pt �% Hardpan dobeX Fill MaterIal!,;,,1,.1 If yes, type ... ..........._ .......... (Plot plan, showing size of fat,_. &tion of gyste NEW INSTALLATION: (No septil an -or a" riVirelation to wells,'bui.1ciiirgs, etc. must be placed oh `reverse side.) p is it,permitted If pubil )�wer is available within 200 feet,) PACKAGE TREATMENT SEP I Sizejt .�!�:—z7r _ -7- - -------- j- Liquid Depth .... ...... -------- Capaci ty' - --- ---....... . ..--- ------------- No.' Compartments --Distcmc4 e a r e st:-Well I . .......... .............. LEACHING L ...-...._..-....._Foundation ----------- ........ Prop. Line..................... INE No. •of Lines --- ---- ---- --------- length th of each line_1 . 9 . ......... Total Length ........._........ 'D' Box - ------ --- Type Filter Material __.._..-,._.____Depth Filter Material ....................... .................... �EEPA6e'pif Distance to nearest; Well ........................4oundation _. ................ Property Line ....................... Depth -- --- ---..-. Diameter ......A Water Table Depth;... Number ------ ............... Rack Filled Yes 0 No 0 .................-V.................._---..Rock Size ........... tw ....:................ Distance to nearest: Well _.......I �ii t REPAIR/ADDITION(Prev. Sanitation I Permit# ......... :1 ----------------- ....Foundation ................... Prop. Line ...................... ---------t....... ............ Date ............ Septic Tank (Specify Requirements) ------------------ f. I j ............................. ... ---------0-...... Disposal Field ............... ,(SP1RcIfy_Requirements) ----- ...........I....... I---------------------------=-.:-..::_:.::..: ............... jii. ----- ---------------- ....................... ............ ........ -------4....z---1...... ........ -1..............:.----_- ............ ............ ..................... (Draw existing and required addition on reverse side) 1. hereby,cei66 that I have prepared this application and that the work will be done In accordance with Son Joaquin County*6rdincincej, State Laws, and Rules and Regulations of-the Son Joaquin Local Health'District. Home owner or licen- sed agents signature certifies the foll?'Wing: ':I certify that in the performance of thework for which this permit is Issued, I shall not employ"r as to become subject to Workman's Co ' �" ' any,person in such manner I I mpenvottiiin laws of California.,, Signed . ............... . ......... -- ----------------------------- Owner By -------- -------- .. . . .. ........ (Ifo er tho wner)'- .. ........................... Title -........C_t2!__r---1--..................... ... FOR DEPARTMENT USE ONLY APPLICATIONFA_CC_PYi!D-T-?-. - - ---- - ------ - -- ........ DATE 7 —C,� ................ BUILDING PERMIT ISSUED ........ ADDITIONAL COMMEN . ............ ----------------_----_DATE .................................... -------- jl_ --- -------6" ............ ....... ........ ------- ------------- .......................... 7-------- .................... A;7- ...... .......... --------- ------- . .. . ........ Final Inspection by:.......... ....... . .. ...... . ....... .. ......................................... ............. ................. ....... ....... ...... "�`]................ .................... --.... ..---------'----..Date........ UIN LOCAL HEALTH DISTRICT E.H. 9 1-'68 Rev. SM