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;.. .. �, :i FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT �S S� . i� (Complete in Triplicate) Permit No. ----- •--- -------• `pd i ------------ ------ Da � �- ka ______ 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�m 11 �cqwith County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS LOCATION --- _T - - sLl -- `` - _CENSUS TRACT _--_-�--2-.-_-•.---- � Owner's Name ----- @@ ��_ � AD-ORID-------------------- ---------- ------------ ---.---------Phone ----------------------------••-- Address ------=--------- ---------- --------- -- City - UYGr3R-Q----------------- - -------------------------- ---- Contractor's Name ------------ ------•-------(gtbluca---------=---------------------=--------License # --------- -------------- Phone ------------------•----------- I Installation will serve: Residence impartment House❑ Commercial ❑Trailer Court ;❑ t. Other- ---------------------------------- Motel = Numbef of m living units:_---J -,_Number of bedrooms _ - Garbage Grinder ------------ Lot Size C3Q ----------------------------- Water Supply: Public System and name ------------------:,11Z1- ---- 4 P-f��" -----A Private [ Character of soil to a depth of 3 f of Sand ❑ Silt❑ Clay 11 eat❑ Sandy Loam`❑""Clay Loam❑"" `" Hardpan❑ Adobe Fill Material'-- ------ If yes,type ---------------------------- LI (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 tank or seep pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT ( ] SEPTIC TANK'S r....,�..Size ___. -_� :. --:------'.Liquid.Depth --_� ------------------- 4,N4 Ca acit1007 ,_- T e - + 0" All [ -- 'No. Compartments _- _- P Y YP /017t°8 }tT% istance to nearest Well@--- - Foundation0------------ Prop. Line ---- --- -- ------ LEACHING LINE No. of Lines 'r - Len' th-'of'each l me -`--..-- Total Length. -: � � ...... ua Box !� -- Type:�Filfer Material Depth Filter Material --------- _-_ '�`'rY . `"-3, '.x. .; ,;: ?,,,:s,_ : '.- `� Distance to nearest..W,el - .:"'Foundation :- (1 -- Property Lute '- -_ - j 41 i -------- ----------- Diamete At%er ---- ---:--- -` ---- Rock Filled Yes ❑ No flr SEEPAGE-PIT [ ] � Depth Water Table Depth ---- `.....:Rock Size Distance to nearest: Well " ---- _ ------_-- �-:---Foundation -------------------- Prap: Line -------_-_---_.____- 3 * ,p v t ----- -------• ----- REPAIR/ADDITION(Prev. Sanitation Permit#'�_'"""'� 'S i��_-Date _ �-I ,,,ti 6pfic ilk (Specify&,Requirements) ---- -- ---. -------- -----------------------------� ------- 0 Qisp0s�wieId {Specify. Requirements) , / ....... --------- ,,: :, , . .� _ --------- ---- : � 4 $ Z .------ - --------—------ - -- --- --V-----= ---- - F (Draw existing,'and required addition on reverse 'side) I hereby certify that I have prepared this apol iation and that the work will begone in accordance with San Joaquin County Ordinances, State Laws, and Rules an'd Regulations of the San Joaquin Locali.Health District. Home owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permifAs issued, I shall«notyemploy any person in such manner as to bec ubject to W n's o ens' 'an laws of California�" jw ' Signed ----------- By - ------- " - = O.l ner hh BY ----- ---------------------------- --- --- --------------------------l-------------------------------- Title ------------ (If ---- - (If other than owner)' 11FOR DEPARTME .US NLY fi F ti APPLICATION ACCEPTED BY ------------------------- -� = DATi.._..6.71 •-------------- BUILDING PERMIT ISSUED ----=------------ -----.------ 1--------- ------:._Vit- . ---- - ------------------DATES- ---...----•----------------------------- . :.... �' ---------------- .------------------------ :Y\----------------------------------------- ----------- ------- --=--------------------------- ADDITIONAL COMMENTS ---- ---- :,- -------- --- ------ --- -- ---------- °- ------------------------ ------------------------------------- ! --------- ---------------- r - = = l Final Inspects ------ ----------------------Date SAN JOAQUIN LOCAL HEALTH DISTRICT E.-H. 9 l-'68 Rev. 5M k_ 3-