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FOR OFPiCE ..�;>r� APPLICATION FOR SANITATION PERMIT Permit No. ............... ._._. ......................................................... T (Complete in Triplicate) s - Date issued ---•. ............. .........-I--.......... ........ . This Permit Expires 1 Year front Date issued . . . .......................................... ... hereby made to the San Joaquin Local Health District for a permit to construct and Install the work herein Application is he Y - • d. This a plication is made in compliance with County Ordinance No. 549 and existing Rules and Rei}u-ations: describe P .._.CENSUS TRACT �•• JOB ADDRESSAOC, ION Phone - ...................... -- Cf� — -tee •--•- Owner s Name -._. Q �................. ........ Ci .• . Address . ... .............. Phone license Contractor's Name ---�.�........... ..`- '1---�-•-••-•-•---...._.. . j A artment House j] Commercial oTraller Court 0 installation will serve: Residence B P Motel ❑Other -_-._.-.-_ rooms -- - Number of bed . Garbage Grinder ...._....._. Lot Size -Lot Number of living units:--__..�--- ...._.-...Private 1 Water supply. Public System and name ...............................:..._ --- - ------ - ..:.... ...................... Loom. Cloy Loam E9:. i PP Y� Cla Peat Q Sandy loo [� Character of soil to a depth of 3 feet: Sand❑ Silt❑ Y ❑ Hardpan fl Adobe 0 Fill Waterlal Y ........,.if es,type--------------------- ..,... . ' n of system in relation to wells, buildings, etc• most be planed an reverse side.( (Plot plan, showing size of lot, location Y i t NEW INSTALLATION- (No septic tank or seepage pit permitted if publlc sewer is availabl within 2Q0 feet,( ..l SEPTIC TANK� � ��------------- ........................... Liquid Depth ........................ 9 PACKAGE TREATMENT l ] . No. Compartments ..=•••.... ........... .. Type ----•---•-..-.__...- lel.:...........: peer _._..._ .. ... Ca tY -..•..-----•- ... Prop. line ..... - Distance.to nearest: Well ----••--•-• ......:.Foundatio ............. � � of a ch line...... .. Total length ...................... . LEACHING LINE I I No. of Lines _ Len Length ....... ........... Material ..............•----•-..... .-. • ---Qepth filter Ma --...----•-•--•--- D' Box Type Filter Material N ....... - ..... Property .......... � Distance to nearest: Well ----•••.._.. ..... Foundation •• ........ ...... Rock Fined Yes �. No Q Depth Diameter -_-•• ......... Number ...................... SEEPAGE PIT [ j P .. (Nater Table Depth ------ •--•--••- •----•--••.......:..:... ' �� Prop. line •--•-•................ f �Foundatlon .................... Distance to nearest: Well _, ._.. �, 1F s REPAIR/ADDITION(Prev. Sanitation Permit# ...•.••-.. - • -.. i -- ..... ..... Septic Tank (Specify Requirements -- ....... (Specify Re uirements) -, f�� ......' Disposal. Field (Sp Y q ••..................................: --------•..:.:............••----------- --•---•--•-- •-•-- ._ {Draw existing and required addition on reverse side) lication and'that°the work will be dons In accordance with Saes Joaquin } 1 hereby certify that I have prepared this app County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Heal#h,Dlstrict. Nanta owner or fin' sed agents signature certifies the following: arson in such manner "I certify that in the performance of the work for"which thl�perrnit Is issued, 1 shall. not employ any p as to become subject tAanowner)an's Compensation laws of California." ` ----•-------- --------- Owner , ?4 Signed -- ------ Title ------ •.............. Y (If other FOR DEPARTMENT. USE ONLY DATE ...2I/-- ... APPLICATION ACCEPTED BY __ _....___ .DAT --.. BUILDING PERMIT ISSUED ------------------------ .._...._..._.------ - ADDITIONAL COMMENTS ----- --•. .........------_------------- -- .......--------------- .---•---•-...__. _.. ....---•------- ? _ £ '.... ---•- --- Date ..__ .1 Fina! Inspection bY- ------------------ 8/7h 3MEH 13 24 1-68 Rev. SAN JpAQUIN L CAL HEALTHDISTRICT