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FOR OFFICE USE: ------ APPLICATION FOR SANITATION PERMIT Issued J --------- (Complete in Triplicate) Permit No. eft - - Tliis-Permit Expires 1 Year From bate Issued Date - - -� 7--• 2.3.3^ ZfOr(� Application is herebf�made to the San Joaquin Local Health District for a permit to construct and Inst described.rThis application is made in compliance with County Ordinance No. 549 and existing Rules andRegulations:Regulationhe work s rein JOB ADDRESS;/LOGATION � �► „� ti ----;`--CENSUS TRACT - me �r : Owner's 40 ► es - o----------- Address " " .� -- City ( -- ------------------- Contractor's Name - f- ._ -__ Q' �^ -� �-- --------- ----------- -- ---=-�--- .License # ------- . -------- Phone ------�----------------------- 1 installation will serve: Residencef-]Apartment House, Commercial Trailer Court Vel � ;❑ ❑Other __----------__" --------------- Number, "_" /r ( 0. ----------- Number,of living units: ' Numbelof bedrooms __=-----Garbage Grinder�----- Lot Size -, Water S4,pply�Public System, and name --------- i. Private,®. /� d - ---------------------Charactet of�soil to a depth of 3 feet• San � Silt Clay y ❑ y ❑ Peat Sand Loam [) Clay Loam :❑ f #. ri3pan Adobe's Fill Material -------- --- If yes,type -Y----- ------ - (Pfot plan, showing sizeoaf lot,floc.ion�of system in relation to wells, buildings, etc. must bei placed on reverse side.) NEW INSTALLATION: (N'o septic tank or seepage-pit pirmitted if 0. ipublic sewer is available within 200 feet,) PACKAGE: REATMENT [ SEPTIC TANK Size._ � � � #d e ' � 141, Liquid Qepth -- ^� i� (3 Capacity � ---- T Materials it -""" No. Compartments Z Yp ` ---..."-:---- Distance to. nearest: Well _ �Q-"------__ " _" -_--_Foundation9— 'r ................ Pro' Line � p• Ae------------ LEACHING LINE No, of Lines ".-_--------------- Length of each line�pZ9-` Total Length t ""�W._�.-,....... - 'D' Box Fs _ f � Type.Filter, Material-4•-"X-, --_--De th -Filter Material a�a: , P --f------- - -•- Distance. to nearest: Wel :, / '" "-"-__ Foundation cam` i ' ------- --------- Property Linn "_. 1 ------ ....... SEEPA'GE PIT DiampAete� ---------- Number ----Z----------�----- Rode Filled ;Yeses` No ❑ r �f' w'at r ,Tabfe Depth -- ! - - ------------- -----------Rock Size _,� s, `' '�, i t Distance to nearest: Well tote_" """""_-"_ Foundation "-�". pro t " I p:;Line ._ ----------- REPAW/ADDITION(Prev. Sanitation Permit�# ---------------- ------------------------ Date -------•-•----••-----------•------1 . r -- { Septic Tank (Specify Requirements) -----------------------j�__ --------------------- Disposal Field• (Specify. Requiremen-s); ----_."a"_ " -- ---- ---- ---- ---- --- ------------------------------- ---------------------- ----- ---- -- { ---- - - -------------- ---------------- (Draw existing and required addition on reverse side)Pt # `Ikhereby. certiIt fy that I have prepared this application and that the work will be done in accordance 1' �.. .- ante -wit,h..San Joaquin �County�Ordinances, State laws; and Rules and Regulations of the. San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: , "l certify that in the performance of the work for whih this ermit is issued1 .sha '�not employ n per- P y Y Person in such manner as become subject to Workman's Compensation laws of.California;'•' Signed ---- ---- --------- i, it Owner .. By A Title _ r (If other than owner) } , t FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .......... -.......... -......................... —w- BUILDING PERMIT fSSUED --------- ---------- -- - - ---- ------------ - --------- �-------- -- ----- DATE--------------- ------ ---------------------------------------------- DATE ---------- --------- ADDITIONAL COMMENTS --------------------------"_"- ----------------- .. ------ ---------- ----------------- ----------------------------------------------------------------------------------------------------- -------------------- ---------- ----------------------------------------------------- "" "Final Inspection by ` Date = =T =_� ► ----------------- SAN JOAQUIN. [LOCAL HEA DISTRICT E. H. 9 1-'68 Rev. SM ' ' �-