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FOR OFFICE USE. APPLICATION FOR SANITATION PERMIT �....... ..:.. .ti ....`,_ ....... . s �,1Camplete in Triplicate) . .� Permit No. ._7�:�_.. Date Issued J _7S .. J This Penult Expires 1 Year From Date Issued i Application is hereby made to the San Joaquin local Health District for a permit to construct and install the work herein described. This applicotiori is made ' compliance with County Ordinance No. 549 and existing Rules and Regulations- ,I JOB ADDRESS/LOCATION..._.__ CE'tVSUS TRACT ........... p ---•.........................• --••-•................. . ........ Owner's Na -' ? _S^.. .../.,?11�J-C F2 .........................• .. ........ --....._....._.Phone Address ... ye. / - .1 / ._ / ..-...-.. .---•- City .. /1.1?.l_- _._C�Tr�f� ..__..__.. ... I �� Con#rector's Name .License # ............. Phone - = - Installation will serve: n Residence Apartment House flfCommercial❑Troller Court I] IMotel ❑Other ; .. ..... ........... ............ ` R r- Number of living units:---.�-::�_ Number of bedrooms .. :.._Garbage Grinder .......::... Lot Size .... G4-C.................... Water Supply: Public System and name.---------•-... :. - ................... - - . . ........................................Private EY Character of soil to a dept of 3 feet: Sand n Silt❑ Clay-f.- Peat❑ Sandy Loom[6"*' Clay Loam ❑ \)N Hardpan[] Adobe fl Fill Materlal yes,type 1 m .(Plot plan, showing size o'f lot, location of system in-relation 'to wells, buildings, etc. must be placed on reverse si�.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public ewer€s avloble within 200 feet,) . l PACKAGE..,TREATMENT I ]M SEPTIC TANK Si��raterlol. .. ..........." .- Liquid Depth Capacity •�-�•�- --.--- Type -.tgea.l � . No. Compartments r LEACHING Distance to nearest: Well ..... ........:..........:.Foundation �. ...�......_ Prop. Line.. d.......... ING LINE ';'NoM. of Lines d Lengt f e l€n Total Length _... 'DISax _�.. Type filter MaterIt N. ep Filter Material .....��.--•-•'-•..................... Distance to.nearest: Well .... Foundation _ .._. Property Llne ... SEEPAGE PIT ( ) Depth ------+-: -::__. Diameter _ Number :....... ....... Rock filled Yes'❑ No ❑ Water Table Depth --- ........----------------------------Rock Size ................................ Distance to nearest: Well -----.•.........:.....•..____...._._. Foundation .._..: .:..: .... Plop. Line ................. REPAIR/ADDITION(Prev. Sanitation Perm it# ................ ..................... .... Date ... ................ ) Septic(Tank (Specify Requirements) ------------ ................ . ................ ..... •------ ---•.......---••--------------••----•----- L . Disposal Field (Specify .Requirements) -----------------------------------------------------.....-- --•----•--- ------. .....-----. .•------ -------------------------- - -------------•------------------- -------------------------------- ................._._........... ------------------- ---- - - ---------------------- ----r-�---F------- ------ --- -------••--•---------••-• -----.__.. -_ ----- ------............ ............ i (Draw existing and required addition on reverse sidel 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 agents signature certifies the following: .. i "I certify that in the perforii:ance of the work for which this permit is issued, I shall not employ any person in such manner as to become sject to Workman's Co nsation laws of California." _ 4 Signed ---� � _ � -- --•---...- _.. : - ................ Owner By ----- ----------------- ---------------------------------------- --------------- --� Jibe -------------------------- •----•- •--••....... (If other thari::owner) 1. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY. 45 DATE,,---- -�-- . . T BUILDING PERMIT ISSUED �....... ........... .. .........._.... DATE .... ADDITIONALCOMMENTSA_..............................................•------_._._.._._......•----_.._-......._...._.--•------------•-_....__.....__._.._---.._..._..-------........ �M ----• ----------'M•................. . ------------------------ �.._ . Final Inspection b R -- ........................... ------------ ..._----------------•-©ate .�-•� --- -...---•---�...._,.---•------- EH 13 24 1-68 lfev• 5I ,SAM JOAQUIN LOCAL HEALTH DISTRICT 3M t