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o OR OFFICE USE: APPULICATION -FOR"SANITATION PERMIT 4 r�u Permit No. ___ , . n = •- M-ompletean Triplicate)-—- _.. _._ ..��S_, - --- - - .----- ------------------------------ :f Date Issued -- --------------------------------- X This Permit Expires ] 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: e a JOB'•ADDRESS/LOCATION .--- --- ---- ---- -- - - - - -------------------------------CENSUS TRACT -------------------------- Owner's Name ----- � ------ -- -�J- ---- - -----------------------------� -------------•--- - - -----Phone iii-74------- Address ---- - -- -a,- .' f`s .'t----------------------------------------------- CitY = o Cont'ractor's Name ____-- ----------- /--------------------- ---------=--------License # _ - fl Phone Installation will serve: Residence Ur Apartment House❑ Commercial :❑Trailer Court i❑ units: f Motel E]Other -------------------------------------------- y i Number of livingunits:-_---f_____ Number of bedrooms ____�' --Garbage Grinder ------------ Lot Size ___--------_il----------------------------- -Private -- --___------'-------- Water: 3Z Y 'C a Peat Sand Loam Private ❑ Supply; Ps�blic S. stem and name ------------------------- I Char of soill t� depth'of 3 feet: Sand'❑ Sift❑ y ❑ ❑ y ❑ Clay.Loam ❑ ' ,r" Hardpan E] Adobe ( Fill Material ------------ If yes, type ____________________ (Plot plan, shoLn.g.si a of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No•}eptic tank or seepage pit permitted if public sewer is available within 200 feet,) �1 PACKAGE TREATMENT { ] SEPTIC TANK'[ ] Size------------------------------------------------ Liquid Depth ---------------------.----- (� I Material______________________ No. Compartments __________. _:_ L,t Capacity _ Type ------------- Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line ---------- .-------. O LEACHING`LINE No: of Lines --------/-------------- Length of each line__x-,00-......--- Total Length __41104.1_-_________-- • 7Box -----/----- Type Filter Material ____,__1_/_/:__Depth Filter Material -------1_-�--1 �---------------••-- l r i Distance to nearest: Well _-__�—`__---- Foundation __-____,l�c_��___ Property Line ---- ' Depth Water To' ie Re Distance o nearest: We :�-�= -- -----------Foundn -_. :P - -- s REPAIR/ADDITiOW(Prev. Sanitation Permit# --•----------- --------------------------- Date _--_------------------------------- , Septic Tank (SpecjfylRequirements) -------- -------�J 1O_T------ - - -----------------------------,f ---------- ----------------------------- ----------------•- -------- t I. f Disposal `Field—(Specify Requirements) ------ - 1 r i t -...� ---- -- ------- ----------------------- — M "" = -- -----------------�-- ----------- ----------------------------------------------------- --------------------------,-- o----------------------- ---------=------- and red on on j I hereby certify that f have prepared(Draw s'app)cation and Ithatatthet'war will reverseside) on)e in act ante with San Jo{ aquin Coun#y Ordinances, State Laws, and Rules=and Regulations of the San Joaquin Locnl Health District. Home owner or licen- sed agents signature certifies the following- I C "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to-become subject to Workman's Compensation laws of California." Signed _.. - ------------.-<--_nrn------------------------------- --------------------. Owner 4- " yo, o ---------------- BY - �� ------------- Title (If other than owner) F R R MENT USE ONLY i APPLICATION ACCEPTED BY _____ -- _____. DATE __ _____� ------- ------Z---- -------- --- - -- --- - - - ------------------------------------------ - BUILbING PERMIT ISSUED -- ----- ----------------------------------- f--------DATE,------- --------------------------`---------- ------- ---- ----- --------- ADDITIONAL COMMENTS ---------------- --------------=-------•--•---------------- - ; - --------r-------------------------------------- ------- ------------------------------- ------- ___-.--_!_________________________-_____-_______ _ ------------------------------- ------------------------------------------------------_---------------J_-____-____-__-_____.__----_________________ _____________________________________ ___r•� _ _ Final Inspection by: ----- ----------------------------------------------------------- -----------Date' -- --- --------------------- SAW`JOAQUIN LOCAL HEALTH DISTRICT ! E. H. 9 1-'68 Rev. 5M �1 y_�