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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ^ 9-------=--� ---------- Com_ �' a '( plefie in Triplicate) --------------------------- p Date Issued �=x-=01 -------------------------------- --- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDS-ESS,/%eGAgRGN -- � ...� �.r.r.3 == = 15 TRACT ------------------------•- Owner's Name l► .l_ ,_ Address _ _ ,. -r- s �' e-f��---------------------- - City = -------------------- l '/l hone ' Con#racto .s Mame - - P fr:- e �= .<c .�_ A _ _„ - _,�_��s-.License # � Installation will serve. Residence,F]Apartment House Commercia) :❑TraileF'Csourt ❑ t i ---- Numberif living units:---- -- .__ Number of bedrooms _„ Garbage Grinder ..__"'-- Lot Size -- ---------Y_f --------- Motel Other ------------------------------------------- Number ---- ----------- -- -------------- --- ❑ y _--.---_ Private .:lNa'rer Supply: Public System and name __�!«l_ �.-----------Cs_.:/�-�-''�------------------- ----- -------- ----••---- -•- ❑ Character of soil to a depth of 3 feet: Sand b ,1"M Clay Peat Sand Loam ❑ lay,Loam;❑ Hardpan E] &dob 'U Fill Material ------------ If Y ,type ------- -------------------- (PI'ot plan, showing ire of lot, location of sys m-4n relation to wells, buildings, ek: must be placed on reverse side.) ! I 1 i able withi 200 feet,) NEW INSTALLATION: (Naeeptic tank or seepage pit permitted if public sewer is ay. SO TANK:[ - -------- Liqui Depth ------------- --- ; PACKAGF TREAT S ENT [ ] ] Cocit T e - - Material No. Com artments ---------------------- PCY --- ------------ Yp ! Distince to nearest: Well -- - ------------------- ---------- undatio - Prop. Line �s - '-Total en th __ --------------- LEACHING LINE [ ] No. f Lines _,!�1�_ ---.4-Length of each line-------- --- -- g d 'D' ox ----�__-- Type Fit#er Mae�l �d��_---Depth Filter Material ---��---------•-•------•--•---•------- j v Dist nce to nearest: ell ----- ---------- Foundation - ---- ---- -------- ..Rr @rty Line ------- ---------------- Ro Filled Yes No 0 [ p iameter - Number I SEEPAGE PIT Det �------- Watt Table Depth - -------------------.Rock Size _-± n� �f 9 "" Foundation _ ---- ---I-- Prop. Line _--�.-:--------- DistIce to nearest: Well ---------------------------------- b, REPAIR/ADDITION (Prev. Sanitation Permit# _ --.._•.-------------------- - Date - '� �--- �---- Setic rank IS ecif Requi.ements) ------------- - -- --- ------------------------- e � p y q - - Disposil Field (Specify Requirements) ----------------------- ----------------------- --------------------------------------- a ------------- ------------------------ ---- -- ------------------------------------------------------------------------------------------------------- --------1-------------------------------------- p e ti. (Draw existing and required addition on reverse si e)� I hereby certify that I have this application and that the work will be don "in accordance with San Joaquin County rdinanc s, State La s, and Rules and Regulations of the. San Joaquin LocalAklealth distrib. Hoene owner or licen- sed agenfs Signa are certifies the following: 1 "I certifythat in he perform nce of the work for which this permit is issued. I shrill not employ an person in such manner as to be I sub e t t==------------ -o Wor� ams-Com_p'nsati.on laws of•Calif nia." Signed 'f= Owner -=- - BY -------- -f----------------------- ------------------------- Title -------------------------------------------- -------------------------- (If Ether than Avned ' FOR-MEPARTMENT-USE-ONLYy- k _ DATE -S-_ - - APPLECATiON ACCEPTED BY ___ - � ._-- - - -z! -- - BUILDING PERMIT ISSUED -----------------------------------------------------------f . DATE ADDITIONALCOMMENTS ------------------------------------------------- ----------------------------------------------------------------------- ------------- ------ _ -- --- --�-- = _ ------------------------------ Date --------- ------- - Date Final Inspection b V- --- -------------------------------- ----------- -- -- -------- --- 6-1 ---- SAN JOAQUIN LOCAL HEALTH DISTRICT C E. H. 9 1-'68 Rev. 5M