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FOR OFFICE USE: !s APPLICATION FOR SANITATION PERMIT - - -------- +� (Complete in Triplicate) Permit No. ------------------ - ---------------------- ------------------------- --------------------------------- p is Permit Expires i Year From Date Issued Date Issued -------------------- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein I described. This aioplicati6n is made in com liance with County Ordinance No. 549 and existing Rules and Regulations. JOB ADDRESS/ C LOCATION _ - t f f � -- '�J---------- .... ------ CENSUS TRACT ----5 Owner's Na ( ;---- . ,- , y Address ._ > W C,- --=- - Phone. ---- -- 't ----- -�12 Contractor's Name _. _- _' f'f - y_;fr� ..•,. --- '. fir.:..:........License # Phone Installation will serve:,.-,,;fin„ Residence Apartment-Ho use'-❑:Commercial-:O Trailer Court.;❑�_a _ _ 1n !Motel ❑ Othe�k "t4_ F Number of living units:__. __-__--_ Num berofTkSedroo ---Garbage Grinder ------------ Lot Size ._------ ---------- _ _,Water Supply: Public System and name_ - - / `' r '- T K!r� �� 2 G Private ❑ ---------------------------------P Ck�aracter of soil fo.a-_depth of 3.feet: Sand ' Silt.❑ PClay ❑ Peat❑ Sandy Loam .❑ Clay Loam [] _. -.. -� . Hardpan Adobe' - —�""' 'T c? NQI ,,�., p = ❑ ❑r�FiO�Material----- �---- I#Yes, type ----------------------- ----- -------------- ----- D� (Plot plan, showing size sof iof, location of system in, relation to-wells, buildings, etc. must be placed on reverse side NEW.INSTALLATION: (No septic tank or seepaT pit-pe tffitted-if�puhlic~sewer is available within 200 feet,) PACKAGE TREATMENT SEPT « { 'a Size----� '-. h`�.e+��----------- Liquid. Depth .. ( C pacit a --.___-- Type _ T-- Material_ �x� P No. Compartments Distance to nearest: Well _- 1 --------------Foundation ----149---------- Prop. Line _----_5 LEACHING LINE No. of Lines ---- " Length of each line------ Total Length --_-� _-_- t 'D' Box _—_ Type Filter Material ` - - ---Depth Filter Material ---_______________ _________ � f . I stance to nearest: Well -/� .4�_____-- Foundation -/C--------------- Property Line --,, f SEEPAGE PIT I -------- Diameter ---------------- [ ] Depth -__._-. Number --____ - ----------------- Rock Filled Yes ❑ No ❑ Water Table Depth -------- Rock Size Distance to nearest: Well R ----------------------------------- Foundation -------------------- Prop. Line ...................... EPAIR/ADDITION(Prev. Sanitation Permit# -------- -------__-__ - =- ibate ----------•- ---------- ---------- Septic Tank (Specify Re 'uirements) ------------ ------._ - -- ---- ----- - ----- --- � -_ - - -- ------ --- Dis osal Field (Specify "Requirements) '-_-�-;Ew. I --- p - --------------------------------------171�(Draw existing and required addition on reverse side)I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaqui County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health District. Home owner or.licen- sed agents signature certifies the following: to "I certify that in the perFarmance of the work for which this permit is issued, 1 shall not employ any person in such manner as to beco a ubject to.Workman's Compensation laws of California." pt Signed -------------- Owner BY (I of -- -- Title-�.-�� • ----- ----- - (If oth r t a owner) - -.-_�------------------------------ FOR DEP ' TMENT USE ONLY ` BUILDING PERMIT ISSUED ' p � APPLICATION ACCEPTED 8Y ... `�?'-Q L r ---------------- DATE ...---- -- - ADDIT ZONAL COMMENTS _-!-----_-__-_ ---------------- -- - -- ------ ------- ------DATE � �� P7 17g�/1-------- ��f�ST`------ --- ------------------------ -- ---- ------------------------------------------------------------------------------ ------------ ---- ----- ----- Final Inspection b . - r Q ------------Date ---- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M