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FOR OFFICE 4M. APPLICATION FOR SANITATION PERMIT a --------- /U/ �. {Complete in Triplicate) Permit No: _-!_________. ---------------------------------------------- _________ This Permit Expires 1 Year From Date Issued 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: ! r JOS ADDRESS/LOCATION ----- [_`1_� -- Jf -�- -,--------- -----"---E--.k----- -�----5 --- -----;-------- ------CENSUS TRACT ------- -�-------- Owner's Name -----�-----�-•----. f -------------•----•-----•--------------------------- -------Phone Cit _ _ — ----- cST�-c-I�-r i- ----------- Address ------------------�.-�-.�-�-------- --�,p-��_�--� - - ---------- Contractor's Name ------��--J- -�L.-� __ City E-f.L.License # : J_ Phone _A,4-4_=3, 112. ' k Installation will serve. Residence%Apartment House-[] Commercial ❑Trailer Court ,❑ Motel ❑Other -------------------------------------------- Number of living units_____________ Number of bedrooms __-- -----Garbage —� e Grinder ------------ Lot Size- ---------_-__-__-- ------------------• Water Supply: Public System and name -------------(,I AL---- -------------------------------------------Private ❑ Character of soil to a depth of 3,feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam.[ Hardpan ❑ Adobe" 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 available within 200 feet,} l PACKAGE TREATMENT [ SEPTIC TANK'[ ] Size------------------------------------------------- Liquid Depth -----------------.._;...-- ka acity - � Diaspance to neas'esf: WePe-- ___ _-_`-_��-�Ma�tenal --- _ No. 'Compartments _____________________ }. Foundationll -------_----'-------- Prop. Line _ LEACHING LINE ( No. of Lines _ g � ` ! `� — ' --- ------ ------� Length of each Zine------- ---0- - -` Totals Length D' Box _- _�____-- Type Filter Materia! _�;_.__12 c_ = Depth Filter'Material _ ________________�_ _ _____-____. -____. R Distance to est-Well---'h___.__ _ _ iFoundati,on ____1.0__+------ .---- Pr _"o Line ______ -------------- 76" �'�. _ SEEPAGE PIT Depth --- __ Diameter 3_______ Number........—1______ __________ Ro-kms i YesZ No 0 �. F 1 V-z Water Table epth --------------- -C?i-- •-____---hock Size ---'-, _t__--t`--- Distance to nearest: Well -------------- -------------------------Foundation ____. _._ _____ __. iProp. Line ___� _...._.----__-- REPAIR/ADDITION(Prev. Sanitation Permit # ---- _. _ z ____________________ Date ____________________ - ..F�-j °• - -------------- - - - 1 Septic Tank (Specify Requirements) ----------------------------------------- a ' =..! ---------------------- Disposal Field (Specify Requiremerfis) [------------------------------------------------------=---- --------- i ------------------------------------------------------------------------------------------------------------------- ------------------------ ----------------------'---- r i (D'raw existing and required addif on on reverse side) I hereby certify that I have preparedithis application and that/he work will be done in accordance with San Joaquin r: 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: d "I certify that in the performance of the work for which this per, it is issued, 1 shall not employ any person in such manner as to become sublect to Workman's Compensation laws of California.; Signed ------------------------------------------- - ------------------------- ---- Owner By --------- --------- 3 - -------------- Title a (If other than owner)t TME NT USE ONLY APPLICATION ACCEPTED BY -- -- -------------------------- ----------------. DATE --- 6--------------- i ---- - -- - - - -- - - - -- BUILDING PERMIT ISSUED -----------°- - --- --- --- - ----- t. TE k ADDITIONAL COMMENTS _ . d _ ? f r---- --- ; ---------------------------------------------------------- -------- --------------- ----- f -- ---= --------------------------- -------------- - --------------------- -- ----------------------------- ---------------------------------- I Final Inspection by: ---------- ---------------- -------------------------------------------.Date -- ---------- _SA__.-JOA = ---- --- _SA_._JOA INN LOCAUHEALTH DISTRICT E. H. 9 7-'68 Rev. 5M,