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FOR OFFICE= USE: APPLICATION FOR SANITATION PERMIT u Pe—It No. i. (Complete in Triplicate) —/�__G --------- - -- Date Issued .� �------ - --- ------------------------- Thi s Permit Expires,) Year Fram Date Issue t ------------ ermit to construct and install the wor ere�n Application is hereby made to the San Joaquin iceLocHealth District fora p • This application is made in compliance with County Ordinance No. 519 and existing Rules and Regulations: described. PP ENSUS TRACT JOB ADDRESS/LOC TION Z/! ' di -----Phone ------------------- ------------- --------------------- ---------- --- ---- -------------- owner's --- Owner's Name ___-_ - ' ss � - Addre ` icense7 Phone __ _1 ----- --- Contractor's Name --' ` Residence Apartment House,[] Commercial ❑Trailer Court 0 installation will serve. Motel ❑ other --------------------------------------------------- �s_a --------- j Garbage Grinder - -- Lot Size -------- Number of living units-------!__--_ Number of bedrooms _____-____-- :_ Private --------------------- Water Supply: Public System and name ----------------------- - Peat F-1Sandy Loam Clay Loam .0 Character of soil to a depth of 3 feet: Sand' Silt❑ Clay F-1 Hardpan [] Adobe ❑ Fill Material ------------ if yes,type - buildings, etc. must be placed on reverse side.] (Plot plan, showing size of lot, location,of system t relation ermitted if public sewer is available within 200 feet,} \ NEW.INSTALLATION: (No septic tank or seepawe g P P ------ Liquid Depth --------------------- --- 6 R r SEPTIC TANK'[;] Size TREATMENT I I _-- — No. Compartments -----------------•---- s �.. -7—T e -------------- ----- Matehal - - --------- ---------------- . Capacity ::_ Type _. • -------Foundation Prop. Line \ Distance to nearest: Well ____------ M.'- ._ k, Total LengfihD No. of Lines -------- Length of each line-- ------------- - - LEACHENG L1NE. [ � i .F .Depth` Filter Material --------------------•-- ---------•-----•--•- 'D' Box ------- ---- Type Filter Material property Line ---------------•-- -- Foundation Distance to nearest: Well"--------------- No ---- --- i f � __-- ��--------_--- Rock Filled Yes ❑ i Depth -------- Diameter_= - :�-- Number SEEPAGE PIT [ ] 4 Water Table Depth ----------- Roc Size --'_Foundation -------------------- Prop. Line ----------------- Distance to nearest: We --- --• -- • � ---- Date ----------------------------------] REPAIR/ADDITION(Prev. Sanitation Permit# --------------l---------- ----- ------ ------------ SeTank (Specify Requirements) r ='F'= ' :, f ' --------------_-- ------------ Septic -- ------ �- `. - - l__-- `eeif Re uirements] �•- - ��------"- - --- - �- ------------------- Up _ Disposal Field •(SP Y _ is.�t ! --------, 4rX�-s ------- Disposal ! - --- - ----- ----------- -------- ------------------------------ - - ---------------------- - j ------------- - - I (Draw existing and required addition on reverse side] �^ ce r h Sun Joaquin I hereby certify that 1 have prepared this application and to County Ordinances, State Laws, and Rules and Regulations f the San Joaquin Local Health District.ark will be done in dCt Homeowner or licen- sed agents signature certifies the following: "1 certify that in the performance of the work for which this permit is issued, { shall not employ any person in suchmanner as to be a subject to Workman's Compensation laws of California." F Owner ----- -- ----------- Signed ------------- ----------- Title ' 'tea C� .. e (if other than o nerf FOR DEPARTMENT USE ONLY --- ------ ----- ------ - DATE ----------------- LIGATION ACCEPTED BY _-- .- - - - - ------------- ----------------------------- I` BUIUI LDING PERMIT ISSUED --- ------------ ----- ---------- - DATE---------------_--------- - • -- - ADDITIONAL COMM1rNTS -----------------------------------------.----------------------------------------------- -------------- � ------------- -- ------------ --------------------------------------- -- Date - Final Inspection by: ------ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M