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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT /y _ '.a• Permit No. �'��'� --- - ---------------------------•- ---------------- {Complete in Triplicate) --------------- ---------------------------------------------------- Date Issued3.-- 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: a ti ...CENSUS TRACT .----_ ------� f _a-. �[� . �Vj- ?4/.--- --------- ---- JOB ADDRESS/LOCATION -- �- Owner's Name _-f_l.$-S /Il - -----Phone - = � -7 ZZ Address - f �- Y /�- - � Cit / �'. License # - ---'- Phone . , _- Contractor's Name ---- __-- _l �lJ_,_ci; ---- -- fr'_ - 1-/1��--- ------ T Installation will serve: Residence Apartment House❑ Commercial [-]Trailer Court l❑ t � # Motel r-1Other ----------------------------------------- Number of living units:-_=--)----- Number of bedroom--------Garbage Grinder -- Lot Size ----RCL4_A-9L'---------------- Water Supply: Public System and name -------------------------------------- -- ------------------- Private J� Character of soil to a depth of 3 feet: Sand'❑ Silt F1 " Clay"❑" Peat ❑ Sandy Loam to Clay Loam yo" 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.) NJ NEW INSTALLATION: (No—septic tank or seepage pit permitted if public sewer is available within 200 feet,] ee r ra PACKAGE TREATMENT [ ]�" E. Liquid De th --------------------•. ANK z --�c------- - =- �_ r q P SEPTIC T rr , F 4 No. Com ----Z.. ...... t Capacity A5 0---- Type' f�LY atenal-° ¢ Compartments lun , n F--------- Prop. Line -------6-•--------- Distance to nearest: Well - --_ ---------• Foundation -:__ - LEACHING LINE No. of Lines __-.Z------------- Length �o-f, each line_ 11 MO------- ----- Total Length! p ---- D' Box ----I---____ Type Filter Materiak - I;• Depth Filter Material f- ------------------••• - E 1 c ,� .. - - -- �- -'� --• �- r �--------- Property Line. ------- - --..... Distance to f aresfi: Well __--�_p-l�-r-_----�F Foundation ----_-._- p tY SEEPAGE PIT Depth -_�_�_-_------- Diamet ----------------------------------- ---- Number -_-------- - --------- Rock Filled Yes'< No 3❑ Water Table Depth ------I- ----------- -------------- ------`hock Size I---��-------------- LOW ---- ------ .-Foundation--../----------•---- Prop. Linev�.�------------- Distance to nearest: Well ___-- - - - m .. t-�' REPAIR/ADDITION(Prev. Sanitation Permit# ----------- --------------- ' Date - ----- -------------------1 Septic Tank (Specify Requirements) ---------------- ------------------------------ ----------------------------- - } ------ Disposal Field (Specify Requirementsl ------------ ------------------------------- r' ------------------------------------------ --------------------------------- ----------- 1 -------------------------------- - seIt1 a� — _ ------------------------------------------- (Draw existing%andJ�pequired addition on reverse side) I hereby certify that I have prepared this applicafion 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. Florae owner or liven- sed agents signature certifies the following: �` r � "I certify h t in the performance o the work for whit this perrmt is issued I shall not employ any person in such manner as to bec m bject to Wor a 's omp n tion of Califor`n�ia." - ----- Signed _ = �� T til+r'► BY --------------- ,. i e (If other than o er) ? OR DEPARTMEFff USE Y APPLICATIONACCEPTED BY ------------------------------------------------------------------ --- --- - - - ------- DATE ---- •------------------ .. € BUILDING PERMIT ISSUED --------------------------------------------------------- --------------------------DATE .----------- ----------------------------- ADDITIONAL COMMENTS ---------------------------- - ----•------------------- - - ----------- I ---------------------------------------------------------------------------------------------------------------------------------------------------------------------- --- ---- ---- r -- - ---------------------- - - k i Final Inspection b ..,c.. -- Date =I - � PY- --------------------------------------------- ----- . - .. . - SAN JO'AQUIN LOCAL HEALTH TRICT E. H. 9 1-'68 Rev. 5M d,r