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- OR OFF ICE. usE: - ,�FAPPLICATION FOR SANITATION PERMIT ' .........:. ....................................... . ••- Permit No. lComplete In Triplicate) - - ..............................._ _ ___________ f This Permit Expires 1 Year From Date Issued Date Issued ,S. ___ -Replication 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 +com 'anceith County Ordinance o. 549 and existing Rules and Regulations: /� rt aOt3 ADDRESS/LOC I ....�f% ... .^ .. _. .. ..... .. ..........................CENSUS TRACT, _ - ` Owner's Name __. :�.. .�T'r :�............. .. . ...... .......Phone . ........ __...A •�� Address ._ 1� �. 4'P•a- Gtr° l •-• _-- .,........Ci G .............. ...... Contractor's Name - --------- ------------------- ----------------- .....License # ......................... Phone r .Installation will serve: sidence❑Apartment House❑ Commercial❑Troller Court 0 Motel ❑Other------------------------ .............. __ Number of living units:____ -__- Number of bedroo `:�....._Garba..a Grinder ............ Lot Size ..._.._ .._- LAg„ :............ Water Supply: Public System and name .......... .. .. .. ........�� .......�_.....,._:._._.__........_,.............,.Private ❑ Character of soil to a depth of 3 feet: Sand ry-ISil ❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ . fHardpan 0 Adobe❑ Fill Material .:::..' ... If yes,type............... ............ (Plot .pian, showing size of lot, location of system In 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,) PACKAGE TREATMENT [ ] SEPTIC TANK{ } j&4drxX r—Size................................................ Liquid Depth Capacity A------------------ Type --------,---- ------ Material------:-------------- No. Compartments .. `� Distance to nearest.• Well _Foundption _.`_ ._. Prop. Line - -.•••--,...... ..___ LEACHING LINE ( ] No. of Lines -------_l............. Length of each line.50_.,XI--------- Total Length .._1. .. �x 3 'D' Box -. ..:__... Type Filter Material __.Depth Filter Material Distance to nearest: Well --°--------------------- Foundation ........................ Property Line ........................ SEEPAGE PIT [ ] Depth --•-- -------------- Diameter _.___.____------ Number .-_--------------._____..... Rock Filled Yes ❑ No 010 Water Table'Depth ___Rock-Size Distance to nearest: Well ..................................... Foundation*------------------- Prop. Line...................... REPAIR/ADDITION(Prev. Sanitation Permit ................................... Date _._.........._..__..__. .......... e Septic Tank (Specify Requirements) --'-.........'_......_----•---------------------------=....................................................................................... Disposal Field (Specify Requirements) ----------A ... -„..... ....... .. .......`... .. ... ---- ----- • -- - -------------- ---- #_. 0 -: "� ------------------------------------ -------------- (Draw existing and required addition on reverse side# � I :hereby certify that 1 have prepared this application and that the work will .be .done in accoraance with San Joaquin r County Ordinances, State Laws, and Rules and-Regeilations-of Ki-36n Joaquin Local Health:Dlstdct. Home owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I ihall,not,employ any person in such manner as to becomp sVb;pct to orIt 's componsation laws of California.” Signed {� ... {,. �✓.._.....--- Owner rr - , I. By ------------------------- - -------------------•--•-•---------------•-------------------------------- Title ------- ' .. . ----......._._.__.... (if other than owner# FOR EPARTMENT USt ONLY / / APPLICATION ACCEPTED BY --------61 - ---- _ - -- DATE -41_ -,r -/...- �1 - ---:_ . ? ' BUILDING PERMIT ISSUED ................ •----- ------•................ � DAT ----- ..... e� " --ADDITIONAL COMMENTS ----- __ . --------------------___-------------------------------------__ _________________________________________._-_-___-_ ______ ____ -_ - -------------.-------------------------------------.........-----_---------- _. Final Inspection by: .---- -- - ---- -------- -------•------------- --- -----Date .... .-..-��- L_-.�.. EH 13 2a 1-68 RAW-r- 5M SAN fOA UIN LOCAL-HEALTH DISTRICT 8/74 3M