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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Triplicate) J ---------'----------------------------------------------- '1 /G --------------------------------------- ------ This Permit Expires 1 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 described. This application is made in corny j "eW County Ordinance No. 549 and existing ules JOB ADDRESSAOC TION . - ------------ --- � _ - �-14'YIfCEI�ISU TRA ------------ _ _ � �- = --------------------------- ------- -----Phone ------------------------------ Owner's Name --- - -fi�-Y _Y�l-l- -�`-/'---- IGh f- / �J ` Address `3 ` = � / - �' ------------------------- City f-Q-S--f/�`77! /!Q/ ---------------------------- ------- Contractor's Name ----- ------- --------- 12r�� -------------------- ---------.License # --7-�3 �? Phone Installation will serve: Residence ❑ Apartment House❑ Commercial :[frailer Court ',❑ Motel ❑Other ----------------------------------------- .Number of living units------------- Number of bedrooms ------------Garbage Grinder ------------ Lot Size --_- _------------___--_----------.-------- Water Supply: Public System and, name ---------------------- -----------••---------------------------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt E] Clay ❑ Peat❑ Sandy Loam •❑ Clay Loam❑ r Ha'r'dpan ❑ Adobe'N Fill Material ------------ If yes, type ---------------------------- (Plot plan, 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✓avaiill�within 200 feet,) �j PACKAGE TREATMENT [ 7 SEPTIC TANK'[ ] Size-- -- - --/`-.-`--- --- quid Depth -- . ---.----::- 2--t, �_ :. , _ �. •.� `� .Capacity -A �--Q-- Type - --Q-?YAlhflatenai�--undation -- -No. Prop. line ---��--=------•- Distance to nearest: Well ____ �--- �y LEACHING LINE [ ] No. of Lines -------------- Length of each line-------�P---_--..-____ Total Length 2:d.-�--_-_--_... 'D' Box ----------- Type Filter Material --------------------Depth Filter Material --------------_------------ ...----- Distance-to nearest: Well --------- -------- Foundation --f!!'_` Property'`Line ----------- -""` SEEPAGE PIT [ ] Depth V ------------------ Diameter ---------------- Number ------------------- ❑ No ❑ "13i -_--__- Rock Filled Yes •. „ Water liable Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ---------_------------ REPAIR/AD Dili'ON(Prey. Sanitation Permit# -------------------------------------------- Date ----------•---.------------._.----) 5epfiic Tank (Specify Requirements) ----------------------------------------- ------- ----- - ------- --------------------- ----------------------------- Disposal - ------------------ DisposalField (Specify Requirements) ------------------------------------------------------------------------------ - ------------------------------------•--------------- - -•, ' = ---------------------------------------------- - ., ----------------------------------------------------------------------------------------------------------------- (Draw existing and required addition on reverse side) f I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws,sand Rules and Regulations of the San Joaquin Local Health District. Home owner or Iicen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to become subjectto Work 's Compensation laws of California." Signed ------ --------------------F--- Owner ------------ By -- ---- - ----- - - ---- Title ;_. (If other tAfl han owner) - a ✓✓✓ FOR .DEPARTMENT II,_0,N Y APPLICATION ACCEPTED BY .--------------------------------- E --�p--=� --------------------- BUILDING PERMIT ISSUED `' ----------o-------------- ------- , ADDITIONAL COMMENTS -------------------------- -------- -------- ------------------=--------------------------- ' - ------------ ----------------------------------------------------------------------------------- :DRI;CTZ---------------------------------------------------------------------------------------------- ---- ' --- FinalInspection by: ------------------------------------'--------------- - ---------- e _ l ---------------- ------- SAN JOAQ IN AL HEA E. H. 9 1-'68 Rev. 5M.