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' FOTO OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No: -. -- ----- �1 ----- ----- ------ (complete in Triplicate) �7/ Date Issued -.-- --- •- ---------=------------------------------- ------------- - p------------------------ 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 Ordinance No. 549 and existing Rules and Regulations- CENSUS TRACT ---- „r JOB ADDRESS/LOCATION .--"- 4?-3-1- _----Phone Owner's Name = Cit Y Address ---------- --- Phone ---- _ R-tlt_K._- License # Contractor's Name --- -o-- S S'� �" rcial ❑Trailer Court [Iinstallation will serve: Residence [Apartment House'❑ Comme Motel ❑Other ------------------------------------------- O 5------------ Number of living units:----- ------ Number of bedrooms --4------Garbage Grinder ------------ Lot Size "------"-----" Private [� --- -- -- --- --------------------------- - Water Supply: Public System an name -----------------" - C10- y- ---F1- El Peat Sandy Loam . Clay LEloam Character of soil to a depth of 3 feet: Sand [3Silt❑------ Hardpan [8' 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 flank or seepage pit permitted if public sewer is available within 200 feet,) Size" "__ -- Liquid Depth ---1- -------- PACKAGE TREATMENT [ ] SEPTIC TANK;[G]� ------ Capacity # �--Q d----- Type P�"�'e�S�Material"" s�W"Er e.i�No. Compartments --------- Foundation ---�-"----- ------- Prop. Line -----170-------•---- Distance to nearest: Well ---------f-"/-o"--------- ------ LEACHING LINE [ l ,n No. of Lines ----�------------- Length of each line--- b ----- --- Total Length -_ -' --------•---- _�--- �.4_U� De th Filter Material ----------------------------------- -- V Box _ CS-- Type Filter Mater�al&Pr P f Distance to nearest: Well ---r�-O-"--_---_--- Foundation _."�"o----- -_-"-_-- Property Line �J 2 Rock Filled Yes [� No 0 Depth 2 Diameter ---`'12"-"--• Number --"- --SEEPAGENT [ ] p --- -- - ---- ---- � Water Table Depth ------------------------------------------------Rock -- --- _-_-----•-Rock Size _--"" - `--Ir 1 -__-_Foundation p ----------------- ----f®-- •------ Pro Line ---------- -------Distance to nearest: Well ""--.----�-� . - - ------ Date ----------- -------•--------------) 0-- REPAIR/ADDITION(Prev. Sanitation Permit _"-.----� ----- - -- ----------- Septic Tank (Specify Requirements) -------- ---------------------------- -- Disposal Field (Specify Requirements) ----------------• ------------ - ---------------------- - --------------------------------------- - -------------------------- -__ ___ - -------- ---- (Draw existing and required addition on reverse s d e h Son Joaquin I hereby certify that I have prepared this application }ontf done in accordance t County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Homeowner or licen- sed agents signature certifies the following: erson in such manner "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any p as to become subject to Workman's Compensation laws of California." Siged -_ c �A'- Owner ,.. P ----------- ----- Tit e ------------------------"__."_"-"-- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --- -------- - DATE _�"`�-y--�-�-�----------------- --- -- ------- ----- BUILDING PERMIT ISSUED ---------------------------------------------- ---- -" -- ---- ------------------------- DATE ----------------- ADDITIONAL COMMENTS --------------------- --- - ------------------------------------------------- --------------------------------------------------- -"Dates Final Inspection bY: -- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M