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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No: ---------------- r {Complete in Triplicate! �- - --------- " Date Issued ---------------------------------- ------------------ - . - This Permit Expires l Year From Date issue County Ordinance No. 549 and existing Rules and Regulations: -- hereby made to the San Joaquin Local Health District for a per to construct and install the workherein Application described. This application is made in compliance with I a -- ,Z,_ . ---CENSUS TRACT ------------- JOB ADDRESS/LOCATION -- ---- -- ��`7 ,,Z r bane ----- -------- ---•- - Owner's Name ------ city ------- ------------•---------------- _ Address - - Phone - - -------- ---- � - �------License # a Contractor's Name - installation will serve: Residence Apartment House❑ Commercial❑Trailer Court Motel ❑Other ----------------------------------------- � -•----- ` �_.---Garbage Grinder .------ ---- Lot Size _��----•-- ' Number of living units:-----!_---- Number of bedrooms __ -------------Private --------------------------------------------- - Supply: Public System and name a -------------- Peat❑ Sandy Loam 0 Clay Loam f Character of soil to a depth of 3 feet: Sand'❑ Silt❑ CIoY ❑� Y e ------ ----- aterial _--_-- -"_-- 1f es,type --- ----------- - Hardpan ❑ Adobe '❑ Fill M etc. must be placed on reverse side.) (Plot plan, showing size of lot, location of system in t permitted if public buildings, is available within 200 feet,) NEW INSTALLATION: (No septic tank orseepage pLiquid Depth -- - { ] SEPTIC TANK�[ ] Size------------------------------------------------ -t-5 � PACKAGE TREATMENT . -. _ _._ Material•--------------------- No. Compartments -- ------ ------° Capacity -------- ------ Type ------------------ i Fou-ndation ------------- Prop Line Distance to nearest: Well ----------- _ _ Total Length --------- - �f LEACHING LINT: ( ] No. of Lines LengtH of eacFi line-------- __ _-_--•---____._-.De Depth Filter. Materia --------- ----------------------- V-D' ----- - ype Filter Material p e Property line. ` Foundation ------------ 5, Distance to nearest: Well ----------------- No Number ----------------- SEEPAGE ------------- Rock Fiiled Yes ❑ � De th i Diameter ---------------- s . SEEPAGE PIT }L 1 ----------------- - p , ' � ---=--------Rock Size --�- --------------------- W er Table Depth --------------------------- ------- ' Prop. Line I Foundation s $. Distance to nearest, Well -------------------- - t ) 4 Date -----------�-------------- REPAIR/ADDIiiION(Prev. Sanitation Permit# ------ --- -- -------------------- ----- ------- � �'.� :. t --- --------------------- 6 Septic TankI(Spe6fy'Requirements) ------------ ._-_-_--_-"_ � � ar ' Disposal i Field (Specify Requirements' -f -----------_F--------------"------ ------ --------- Ir --------------------------- -- ---------------------} ..........- - ------- - � OZ.S -� f. -----JJ_ "'."-__-�6i y -_ -. (Dan require addition on�reve se side) ,. lication and that the work will be done in accordance with San Joaquin I hereby certify that I have prepared this app 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: errn;t is'issued, I shall not employ any person inisuch manner "I certify that in the performance of the work for which this p { ` as to bec me s b'yect to ork n's Compensqlaws of California." t Owner ,1 Signed / \,11 ---.#- - ------ ------ ------ Title ---- -- - - ---- ------ ----- - (if other than owner} ' t FOR .DEPARTMENT USE ONLY I _ f/ -C�, ---------------------------------------------------------------DATE _,S. --7-f--�-�---•-----------•-----APPLICATION ACCEPTED BY ----------------- ---------- -- DATE BUILDING PERMIT ,ISSUED -------------------------- t ADDITIONA a COMMENTS ------------------- --------•----------------------------------------- r r - ------- -------------------------------------------------------------------------------------- ---------------------------------------------- ----------- -------------- ---- -- ------------- --- -------- Date s f --- ----- - ---- -----'-_-_[-"'-_! -_-""_- "_- q -- ------------------ - -- - _ --------------- - -(-- ( `' Final Inspection by --------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.