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FOR OFFICE USE:U&^ APPLICATION FOR SANITATION PERMIT 0 70J7 (Complete in Triplicate) Permit No. - --- -- This Permit Expires 1 Year From Date Issued Date Issued '7Z]. t 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 compl' a with County Ordinance No. 549 and existing Rules and Regulations: k ' JOB ADDRESS/LOCATION .-_ - - --- ---- -- - -- Ala -._--- ----- ------------------ CENSUS TRACT ----------------------.. Owner's Name ---------------- ---- - Phone ` %' :01 Address ----------- s Contractor's Name -- _ _-- _-- I --�. _-- -------- _ - _ --- Phone - ------ --- �f License #��t�"S/r0 Installation will serve: , Residence 24 artment House-❑ Commercial❑Trailer Court ;❑ Motel ❑ Other Number of living units:______ ___._ Number of bedrooms -7-7--Garbage Grinder ._______ Lot Size O Water Supply: Public System and name ------------------- -`-- C-- - '`-^--------------- ------- Private ❑ Character of soil to a depth of 3 feet: Sand' Silt /Cla P tod I ❑ ❑ y ❑ eat❑ Sandy,loa CI�y Lo atm ;❑ Hardpan ❑ Adobe' ill Mo erI aI -------- If yes, type ----- ------ -------- (Plot plan, showing size of lot,' location of system in relation to � wee lls,6uildings• etc. must b"e�plat ed on reverse side.) NEW INSTALLATION: {No sp sea e pperm1Zed if public-1sewer,rs'available within 200 feet) PACKAGE TREATMENT [ ] SEPTIC TANK � e )-AV--------^=' ------��Liquid' Depth: ------------ ------------ Capacity -------- � Ca acitY ----- -------------- Type ---------------- Maerial • = No. Com4att ents J Dige r6cto nearest: Well -------------- ------,---__ Fojjundation ------- --"-- -- Prop Line ---------------------- i l3 LEACHING LINE o. f Lines .____._____________ ___ Length of each line_ ______________________ Total Length Z ............. D' Box _____.------ Type Filter Material ---------_--+------Dyyepth Filter Material ---_----#--= .- --- Distance to nearest: Well.------------------------ FouYndation _-------.-_--- Property 4.Z e _________.--------•_-... SEEPAGE PIT [ ] Depth _�__________________ Diameter ________________ NJmb�'er ----------------- Rock Filled. Yes ❑ No Water Table Depth ----------------------------------------J)--.. __Rock Size---------- -------------- Distance`.to nearest: Well --------------------------------1__.1.Foundation -----U-------- Pr p. Line -------.._..---------- I REPAIRJADDITION(Prev. Sanitation Permit# -•-------------------------------------- --- Date __` -.----------- -- _ Septic Tank (Specify Requirements) ------------ ----- - ---------------- bisposal Field {Specify Requi ements) ____�_r____- -/ .______ ? ----g------- 5I -- o5_- �I _ ' _ 4 --------------- ------ ----- a �-- -a. �.. _ �. k __ � E -- ---- '" (Draw exi ng.and,requirec�raddltion� r0ers° side) I hereby certify that I have prepared this application and that the work will be done in accordance gni}th'Son Joaquin 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: "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to bec meAD" ect to W rkma;'s Compensation I ws of California." Signed _ _._ Cl -------------- - BY ------------------------------------------ ----- ------- -- -- Title - ------------- -------------------------- (if other than owner} FOR .DEPAilTMENT USE ONLY APPLICATION ACCEPTED BY --------------------- ------ DATE U-_Zc'�' �f BUILDING PERMIT ISSUED -------- -- -------DATE ADDITIONALCOMMENTS --. =-------------------------------------------------------------------------- -------------------------------------------------------------------------- r ----------------------------------- ------------------I---------------------------------------------------------------------- ------------------------------------ :------------------------------------- ----------------------------------------------------=----------------------------- ------------------------------------- ----------------------------------------------•------------------------- ------•- ------------------------------------- ------------ ------------------_------- Final Inspection by: -------N-" 41i-------------------------------------- ----------------------------------------------Date _----�+� --- -------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M `