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FOR OOFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. 4--:7k (Complete in Triplicate) ) ---------f -- ----- Date Issued This Permit Expires I Year Frain Date issued ---------- ocal Health District for a permit to construct and install the work herein A I at'on is hereby made to the Son Joaquin L o. 549 and existing Rules and Regulationst' pp This application is mad described. e in compliance with County Ordinance N CENSUS TRACT -------------- .......... JOB ADDRESS/LOCATION -- ------ -------------- Phone ---------------- Owners Name -- ---- y ---------------------------------- 44- -t9l Cit Address --- 5/_5� ------ ense* ---- Phone --- -------- - - _.Lic ------------ Contractor's Name Installation will serve, ResidenceXApartment House-❑ Commercial T-ITrail6r Court ❑ Motel []other -------------------------------------------- 157D ------------- (`- •--_-- Number of living, units:.__- Number of bedrooms ___f2----Garbage Grinder ------------ Lot Size. - -_ _/ ---Private E] It Water Supply- Publit'gystem and name ------��__w ---------------------------------- [] Sandy Loam ,E] Clay,LoamO Character of soil to a d9pth of 3 feet, Sand 0 Silt C1 Clay 11 Peat Qt" Hardpan 0 Ado --be Fill Material ------------ If yes,type ---------- ---------------- -1. - reverse side.) ol, location of system in relation to- wells, buildings, etc. must be placed on (Plot planjshowing size of . available within 200 feetj NEW INSTALLATION: (No.!septic tank or seepage pit permitted if public sewer is civ -------- Liquid Depth -------------- ------ PACKAGE TREATMENT I SEPTIC TANK Size---------------------------- ----------- _.t. Material---------------------- No. Compartments ------------------ Ir Capacity -------------------- Type 777='F6Wd-afi6n -------------- ---Prop. Line ---------------- ------ I Distance to nearest: Well ----------------------- #t 0 ach line-------------- ------------ Total Length -------------------- Njo. of Lines ------------------------ Length of e LEACHING LINE ,p, Box ----- ------ Type Filter Material ----------------Depth Filter Material I ---- Property Line --------- --------------- Distance to nearest. Well ------------------------ Fouridytion -------------------- V�. I Rock Filled Yes No .[I Diameter ---------------- Numbdr -- --------------- SEEPAGE PIT Depth --------------- IV -0, A I Water Table Depth ------------------------------P---------- -------R8& Size--------------------------------- 'Z� I ------------- Prop. Line --------------------- Distance to nearest-. Well ----------------------------------------Foundation ------ Permit# ------------------------------------------- Date -------------------------- REPAIR/ADDITION tVev. Sanitationi I o-KJ' I ---------------------- --------- ---------- Septic Tank (Spcify Requirements) --------------- Disposal Field (Specify Requirements) /- - I --- --- r/ ------------ I ---------------- -------------------------- I -------- ------- -------=---- ------ ----------------- --------------- ---------------------►---------------------------------------------------------------------- (Draw existing and requir6d addition on reverse side) with Son Joaquin I hereby certify that I have prepared this application and that the work will be done in accordance V County Ordinances, State Laws, and Rules and Regulations of the San Joaquin'Local Health District. Horne owner or lice n- 1 agents signature certifies the following' ierson in such manner "I certify that in the performance of the work for which this permieij+jssuecl, I shall not employ any p California.' as to be ubjectvt77 ,)Work��nls Come sat -n-laws of ai _ge subier� ► Owner Signed Title -----I---- ----------------- ------------------------------------------ By -------------------------------- ---- ---------------- -- (If other than owner) FOR DEPARTMENT USES ONLY DATE - --- ------------ APPLICATION ACCEPTED 11 -------- -- -------------- DATE --------------------------------- ------- --------- ----- BUILDING PERMIT JSSUED -----------------------------------------------------------------I--------------- ADDITIONALCOMMENTS - ------------------------------------------------------------------------- . ---------------------------------------------------------------- ------------------------------------------ --------------- --------------------------------- -------------------- ------------- -------------------------- y ------------------------------ - ---------j------------ ------------------------ -------------•-- --------------------------------- ---------------------F Date --- -- -- -- ---- ---- Final Inspection by: ------ I N. SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-,'68 Rev. 5M.