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FOR OFFICE USE-i '' fm APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. <. Date Issued ---------------------------_._.-------------------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the'Son Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordidance No. 5.49 and existing Rules and Regulations- -J. JOB ADDRESS/LOCADO N .._._.-13_1_3_Za__— Q" �_ -------------------------------CENSUS TRACT ---------------.------- Owner's Name ------- "_Ai---------AltD IM_;---------- ---------- :• = Phone Address ------------1.7"7-T3-----S--------\J- -------- ---- - City ------019P _D6 nF_ Contractor's Name d8n..._..T_ HQ/ir1_S------SL#-T1C.____TRN_KS__--License # Phone Installation will serve: „ Residence p-Kpartment House❑ Commercial:❑Trailer Court ❑ ' Motel ❑Other -------------------------------------------- Number --- ---------------------- ---- Number of living unit�s'��__ ______ Number of bedrooms ________Garbage Grinder -_-A __ Lot Size __X__AP---- Water Supply: PuY49 System and name�-------------------------------------------- Private Character of sc i o a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam -❑ ClaV-Loam'[ - f Hardpan Adobe Fill Material _A/0--- If es, type ❑ Y e ---------- ----------------- s' r� ,� �. t_ r z -- -ngs, etc. must be placed on reverse aside;} 1'FEIAI, f5irAL4ATION:r (No..s`pticjonk:r seepa pit permitted if pybliic sewer is available within 200 feet,) � w P4 :AGE TREATMEN T- [� !f% ' ' [ ] ERTIC,TANK Size------ -------��.k-5 Liquid Depth . -------- Capacity Type�F__CA`_ Material: { No. Compartments v i Distance to nearest: Well ' ---------------- ___Foundation _1 __-_ ...... Prop. Line ___S 4- LEACHING LIME ( No. of Lines _____ ------------------ Length of each line' ____________ Total Length ______.l---©___--_._.__ 1 D' Box/YF-s_ Type Filter Material RPS ___:Depth filter Material -------/9.......------------------_--- Distbirce to nedrest`Well -.-- ------------ Foundation'- _.1 ---'+--------- Properly i*e ---------- -+ SEEPAGE PIT +" r r ' ` ( Depth �� .°--------._ Diameter �X_g----- �i+�er -'-`----�- --------- itadc filar Y4c 23--*19 Q p -----R�t Water Table Depth ----.��--4 - --------------------• Distance'to nearest: Well "10Q-- -----------•-------Fount ation-"--149------`- --------------- ..---- 9AMWADDN� (Prev. Sanitation Permit# -------------------------------------------- flats `-'----- -----------------------I Septic Tank (Specify Requirements) _-------------------------------------------------------------- _ = ---------- ------------------ - --`��14 -------- - Disposal Field (Specify Requirements) ------------------------------------------------------------ --------------------------•--------- -- -- ----- ------ � -----------------------•--------------- :r ---------------------------- --------------------- --- (Draw existing and required addition on reverse side) 4 I hereby certify that I have prepared this application and that the work will h* dme in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District.Ham* owner or licen- sed agents signature certifies the following: "I certify that in the pe ante oft work for jZE rmit is issued, I shall not employ any person in such manner as to besubject rkman's o pen tianfornia." Signed ------ Owner BYL ---- -��1'c.0 ---- Title ----------------------------------------------------------------------- (If other than owner) FOR DEPARTMENT _USE ONLY ` j j - - �~ �- APPLICATION ACCEPTED BY -.____ _ i_R_O ,-- -- f ' " - ------------------------ ----- -- - DATE -------.��.1�'--�-�-------- BUiLf3iIVG=PERMiT ISSUED-M=_ `__ ._._ �. � w_ DATE-�---- -------------- --- ---------------------------- ADDITIONAL COMMENTS ---------------l_T_._"( to I�lf f 4i D s-------- ----�5�--------------------------____--_____.__ __.___ _ __________-.___.__________________ �4 _ -------------------------------------------- ------- } i ------------------------------------------------------------______.____________-____-________.__._ ------------------------------ --- -- - -- ------- ----------- ----- --- - -- ___________ f- Final Inspec ' .r ---------------------- -------------------Date ----- u SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.