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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -- - -- ld��-�-`---------�� ------ ��.�-`�1-,� (Complete in Triplicate) Permit No. / ________________-A --------------------------- 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: JOB ADDRESS/LOCATION .-- ----r � ---�--- ------- ------ ------------------------------CENSUS TRACT -------------------------- Owner's Name ------- -------moi". --------------------------------- - Contractor's Name -------------------- -- - � ----.License #145----; --- Phone --------------•------•-------- Installation will serve: Resicl::e XApartment HgUse,❑ Commercial ❑Trailer Court ;❑ Motel ❑Other.---------'I--------------------------------- Number of living units:------- Number of bedrooms __ _-Garbage Grinder _____.____ Lot Size ---6-0-Y-13-4 Y name - ---` _ --- ------------------------------Private ❑ Water Supply: Public System anc Character of soil to a depth of 3 fzett"!`,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 publinseweris available within 200 feet,) PACKAGE TREATMENT [ ) SEPTIC TANK�[ ] �_ _ Size-------------;--------------------------------- Liquid .Depth -------------------------- Capacity TYPe ----------------- Material--------------------- No. Compartments ------- .............. Distance"to nearest: Well -___.-__:.-_ I -------�------------i._Foundation ---------------------- Prop. Line ...................... LEACHING LINE [ ] No. of Lines ------------------------ Length of each line__ .----------------------- Total Length ---------.-_--------------- 'D' ,_...............'D' Box . Type Filter Material -__------------- --Depth Filter Material -------------------- ....................... Distance?to nbarest:' Well -------- Fourfdation _______ _________ t___ Property Line ._-_ ------_ _ -_---- SEEPAGE PIT [ ] Depth __<____-_'_______ Diameter ---------------- Number _____ __ - Rock Filled Yes ❑ No i❑ Water Table"Depth ----------------------------------------- ------Rock Size--------------------------------- Distance to nearest: Well _______________R_j.--.--.---.-- ___ ._Foundation -------------------- Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# -----------#._`Date ---------------------I------------- Septic Tank (Specify Requirements) ---------------------------- -------------------- ------------------------,,---------------------------- Disposal Field (Specify Requirements) -------- ----Q ------ ------- - -- -- ------3--- c. ----- -----�=-- '_. --- _cox -------- (Draw/e is?f ting and required addit on reverse side) I hereby certify that I have prepared this application and that thewk will bel Health District. Home done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Locae owner or licen- sed _.__._.�...._ _.._ _ a sed agents signature certifies the following. "I certify that in the performance of the work for which this Fermit is rued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws-&-tatifor'nia." ~` Signed ------------------------- - -- -------- ---- Owner , BY --------------------- - -- ------- ------- -, ------ --------------------- Title -------------te_6 (If other a owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------ BUILDING PERMIT ISSUE - -- DATE - --- ------------------------------ ------ ADDITIONAL COMM ENTS"_�,-olc ' --------------- ----------------- -------------------------------------- a tm•- - •. - .P��__ --;�,��,,,�Y, .�t� �r�-C _� � ------- -----------------------------------fig/ 4 .�, �T � � - -------- - - a �� Final Inspection by 0,0 ----------------------- -- •-------------------------------------D e ---�/=�--- -- ---- - - ------------- �f SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M