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4 FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT M ------- -------------- ----------------- Permit No. (Complete in Triplicate) --------' Date Issued �----------------- -----_------------------------_--_--.---- -------------- This Permit Expires I Year From 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 compliance with County Ordinance No ,549 and existing Rules and Regulations: JOB ADDRESS/LOCA TIO ` -- CENSUS TRACT -- PR5 Owner's Name ------- ____ .. �`�--------IV V----------------- — ---Phone--------------------- Rwx Address ---------------- -------------------------------- ------------.. _-------------Cit �C. Contractor's Name -- ---8V�WjIE�----------------------------------------------------------License # ------------------------- Phoneme-------------- ....... Installation will serve.-- r Residence Apartment House❑ Commercial ❑Trailer Court ',❑ i fr' Motel ❑Other, --------------------------------------------- Number of living units:------- -___ Number of bedrooms-_-:Garbage Grinder /; __ Lot Size ----- C -E - —_______ Water Supply: Public System and name ----------------- -----------------#--------------------- ==-----------------------------------------n__,__Private Character of soil to a depth of 3�feet: Sand'❑ Silt Clay E] Peat E] Sandy Loam ❑ Clay Laam � r� Adb Hardpan j�� -E]e- 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 availa le within 200 feet,) TREATMENT { ] SEPTIC TANK'[ ] ' Siz4------------------- -----�_- --�tT-- --- Liquid Depth ----------------------•--- A '__ Material -------------- t o. Compartments -.----.---_------:---- PACKAGE TRA {j Capacity -------------------- TYp ------- ti p 0 Distance to nearest: Wel ----------------- -----------t------Foundation --�--- ------------- Prop. Line __.------------------- 14 0 LEACHING LINE! �[ ] No. of Lines ____________________ ___ Length of each ;line------------------------L_ Total Length --------- _..__________-_ N -- D' Bax ------------ Type Filter Material --------------------Depth Filter Ma erial __________________________..•.--------__-- Distance to nearest: Well _______________________ Foundation _____.___________-- ---- Property Line -----------.._____-_____rn SEEPAGE PIT [ ]_+, Depth -------------------- Diarr eter ----------7- =1------------------ ____ Rock Filled Yes ❑ No 0 Water Table Depth _______ _ _ ------------- ------• •--------------Rock Size ------ - ------------------- Distance-to ------------------Distance-to.nearest:�lNell )_1- ".-----------------------�.-..Foundation ----- ------------ Prop. Line ....................2 ) Z. REPAIRJADDITION(Prev. SaM#cttaon-Perm.if-Y#�-�:�• --__-'_-__4-------------,n Date ---------------------------------- � a p Septic Tank (Specify Requirements) ---------------------------------------------------t --------------------------- -•--------------- ------ 1 Disposal Field�Specify Requirements) ------tfu . . ....... --- ,--- - ------ C ! - _______ ________ ___ ISN-1 n! -________1_VAC1 E_(Pl/ ________-VIA-5T�5---------------0 --- ______________-- -------------------------=--------------------------------------------------------------------------''------------------------------------------------------------------ ----------------•--•------------- (Draw existing and required_addition on reverse side) I hereby certify:that'll have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents s' nature'certifies the following: "1 certify a in the performa c of t work for which this permit is issued, I shall not employ any person in such manner as to bec a sub- ct to Wor pensation laws of California." Signed ----- =----------- -- - -- ----------------------- --------------------------. Owner BY --'-------------'-----------'------------------------------------------------ Title ._.. - '- ------------------------------------- (If other than owner) '� FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----7-3 X-0---------------- =,---------� E 4` _t\s..` )`;=DATE ----- -`. . ----------- BUILDING PERMIT- ISSUED_=- _---------------------------=--D--A---T--E- DATE'_- _-.___._...._.---•-•------ ADDITIONAL COMMENTS ---- --- - - --------------------------------------- ------------------ ------------------------------------------------------------------------------- ------- - -------------------------- ------ ------ ----------- ---------------------------------------------------------------------------- -- ------ ---- --- ------ -- -- -- - / - /Final Inspec - ---- -- _r----- ------Date ------- SAN JOAQUIN LOCAL HEALTH DISTRICT �F E. H. 9 1-'68 Rev. 5M