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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ` Permit No: -----------------------------9- ------------------- {Complete in Triplicate} --- -- ------ Date Issued ---- This Permit Expires 1 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 OrdinancetNo. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATIQN .----1 -� -�-- ----- tj ---46 CENSUS TRACT _ ii II ---------------------- _ Phone Owner's Name .- Address ------ - --S------------•- _ f1 ---------- city ---- ---�-- -!------------------------------------------•---------- ' Phone ----------------------- Contractor's Name t� N ---------------------------- �izense # Installatior�,,Will serve: ResidenceKApartment House❑ Commercial:❑Trailer Court l❑ ..4' Motel ❑Other -------------------------------------------- CICA Number of 'I'lv.ing units-.---/- _ _ _____ Number of bedrooms _ ____Garbage Grinder _- ___ __ Lot Size ________ __ Water Supply,,�pu.blic Sy..stem and name ------------------------------------------------------ Private ----- { Peat Sand Loam Clay Loam ❑ Character of soil i•o a depth of 3 feet: Sand❑ Silt Clay ❑ Y ,_' {' 1 Hard ari Adobe:[ Fill Mafierial _____-1 -__ if yes,type --------------------- - - p iR1-.__ _ . `'.. i [Plot plan, showing's ze of lot, location aof stem in�r, at�io4to wells., buildings, etc. must be placed-on.reverse side.) k NEW INSTAELATION� `(No septic tank/or seepage it permitted if public sewer is available within 200 feet,) �- . - Li uid Depth ---- Size_-91_; _ � q P PACKAGE TREATMENT [�� SEPTICf1'ANK� -------- ---- - 4C�.-- Type - _ _ afierial � No. Compartments ----_.---�-.. Capacity�l! Yp i JM". - Foundation., Prop�Line _-Disfance--to-nearest:Well ___-_ --- I LEACHING LINE , No. of 'Lines ----- ------ Length of each line------711-------- Total Length __-. -=-----• #.-------.- p�,�o s Type Filter Material RvjcK--Depth FilterMaterial -_ Distance to nearest.. Well -- - " Foundation ___ Property = i mow- _._ . __..�.�.-.., .. ,�_. --- Pro er Line 1 RockT �lled Yes� a�❑ SEEPAGE PIT Depthiameter - i Y ----- -- f,r Wafer Table jDepth __ - ----- Rock Size _ Z r ---- r rE f '." P op. Line ._ _ ....._.. ti`stance�tornearest: Well -- ---------------------------Foundatio REPAIR/ADDITION(Prev. San"rtaI Permit+ -------------------------------------------- Date --------------------------------- ) jr k Septic Tank (Specify Regarir ments) ------------ ------------------------------ `ems---------------------- --------------- ------------ �Dis oral Field (Specify Requi } k ------------------- ' 4 i r Kr __________________________________________I'__-____________-_____-______-___k____________-__4_______________.__•__-___________-_- __________-_-_____._____,__-__._______ �i_____1 _____________________ (Draw existing and requi"red addition on reverse side) '" that 1 have re area this application and�tliat the work swill be done en accordance with',Sa�3oaquin I hereby certify _.p p County Ordinances, State Laws, and Rules and Regulations-of the San Joaquin Local Health District. Home o nor-or licen- sed agents signature ertifies the following: ii; "I certifytain /pe or of the work for which,.this`p'ermit-is issued, I shalt not employ any person in such manner as to becoW . an's Compensation laws`of California. — OwnerSigned ---r4.c�'"�:.� - `-------- Title -------- ----------- ------------------ --------- BY ---------------- -------- ----- - ----------- By t {If other than owner} FOR DEPARTMENT USE ONLY r w - - -' - - ---------- --- -- =t tDATE ---- --- APPLICATION Y � BUILDlNGERM-TISSUED� --------�---------�------ ------= - DATE -------------------- • " - ADDITIONAL COMMENTS --------------------------- --------------------------------W -- ------- ------- --- - -------- --------------------- ---- -- - ------------------------------^ -------- Date --- Final Inspection / ----------- - --- - - - SAN JOAQ LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M