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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 7 S- Permit No. -- ^- ---- ---------------d49----"------ (Complete in Triplicate) Q Date lssued _.-6-- /3'�S ----- --------- .Y ------------- This Permit Expires 1 Year From Date Issue ruct and e work Application is hereby made to the San Joaquin Local `Health District i tOrd Ordinance Na 549 and a permit to ex sting Rules tand hRegulations,a+n described. This application is made in compliancei CENSUS TRACT -------------------------- JOB ______________________ __JOB ADDRESS/LOCATION .-W---- / 7- 7 .-- ------------- Phone `��- Owner's Name - ,� a Cit �------- ------------ -------•------•------•--- , �S— -------------=------------ .c['66' Address --------- ------------ -- -�------.License # -----�-,�- ------ - Phone -------------- - -• -- , Contractor's Name ter' moi` p-�C f 'S/__¢- ------r , installation will serve: Res iden ce;Apartment House❑ Commercial :❑Trailer Court ;❑ Motel ❑Other --------------------------------------------- ----- ------------- ---- ., e4/4�7`-.----- Number of living units:-----�---- Ni tuber of bedrooms----Garbage Grinder ------------ Lot Size _. -___ _-______________ __ y ------------------------------Private Wafter Supply: Public System an name -------- peat Sand Loam ❑ Clay Loam ❑ Character of soil to a depth of 3 fe`t: Sand'❑ Silt❑ Clay ❑ ❑ t Fill Material ------------ if yes, type ---------------------------- Hardpan ❑ Adobe ❑ ' buildings, .etc. must be placed on reverse side.) `� (Plofi plan, showing size of lot, location of system in pelation ermitted if public sewer is available within 200 feet,} ' NEW INSTALLATION: (No septi tank or seepage pit p Liquid Depth .` -`{h A PACKAGE TREATMENT [ ] SEPTIC TANK![ ] Size---- ��pp +' l Type Material.1- No. Compartments -- ,y z Capacity'---- --- - yp �.. r --- Foundation Prop. inti . - Distance to nearest: Well _ ---- -- ----------- T 9 otal Length 'LEACHING LINE [ ] No. of Lines __---------------- Length of each lir§e____------------ ___.I_De th Filter Material - - ----------------------•------ - 'Q' Box i___________ Type Filter Material __"________-- p � - - ' ti Found tion � �- ;-� Property Line ------------------•----- Distance�to nearest: Well ------------------------ ---------------- -"-- f 4 ... - Rock Filled Yes ❑ No iQ Depth Diameter ---------------- Number y, :SEEPAGE PIT [ 7 ----------------- i Rock Size Water Table Depth --- i ---- - S 1 -------------------Foundatn -- _•----- -------•- Prop. Line .-------------�•- / Distancelto nearest: Well ____-_____________-- -io -- -- -------------------------- Date.::------------------Ar } REPAIR/ADDITION(Prev. Sanitation Permit # --------- -._�--- _ -----------.---- -------------- Sept r ---- ' =- ic Tank (Specify Requirem+ents} ____- { Disposal Field {Specify R�eq4ue nts} _-- - --- --- �� n C e- -' = --- . f r (Draw ex+sting and required a +tion on revers +de} ,r t 1 hereby certify that I;have prepared this application'arid"that the work will be done in accordance with San Joaquin ; rCounty Ordinances, State flaws, and Rules'and'Regulafions of the•San Jo agvin Local;Health District: Home owner or licen--; I' i 4 Ised agents signature certifies the following: I - person in such manner i "I certify that in the performance of the work for which this permit is issued, I shall not employ any as to be a sub' to Workman"s C nsation laws of California." o � �t Bisic Title -r3 -- --------------------------- ---------- t ,,,_„(;w„-„ _�(lf.other-than owner)__ ,,.� f„ „1, FO DEPARTMENT JOE ONLY } DATEr T ------- I APPLICATION ACCEPTED BY -- - -- -- --------------------- ---- ------- -- - ---I-----�� ---, ------------------- ------- ------------------ DATE BUILDING PERMIT ISSUED ------------------------------------------------ ------- ----- ------------------ ----------------- ADDITIONAL COMMENTS ........ ------- - -------------------•------- ----- ------------------ - - ---- ----- -- - ---------- Final Inspection y: .____. --,^ ------------------------------- SAN JOAQUIN LOCAL HEALT ISTRICT F H- 9 1-'68 Rev. 5M