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FOR OFEICE'USE: "' - APPLICATION FOR SANITATION PERMIT u . . ---------- ----------'A'',-=----- - Permit No: (Complete in Triplicate) --------------------- __ _____________--------------- This Permit Expires 1 Year From Date Issued DV, Issued..__ _; _�l_-7l Application ik,hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein .4 described. This application is made in compliance with County Ordinance No. 549 and existing_Rules and Regulations: JOB ADDRESS/LOCATION .--1_DI_- ------- ----- --------------------------------------------------CENSUS TRACT .- `- ------- A Owner's Name 2-awls---------S-n--acrPhone ':---•---•- =p,ddress ------ 1-01 -- � ------SIFM ------------------------------ ------------ City _ NYE 1 ------------------------------- .: p Contractor's Name ------- ---------------------------------------------------------License # ---- ---------- Phone ----------------------------- Installation will serve: Residence X Apartment House.,E] Commercial-E]Trailer Court ,❑ Motel Ej Other ------�---------------------------------- -- Number of livih units:---_ _______ Number of bedrooms _ � ' - g j _ Garbage Gr�ndery� %T��E14��.--____-- ------ ,9 �: Lot Size --- ------------•=-- -- -- Water Supplyr Public System and name ---------------------------• ------------------ i - ------------------------------------Private ❑ i Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑Peat❑ Sandy Loam JX Clay Loam :0 Hardpan ❑ Adobe ❑ Fill,Material ------------- If yes,type _________________________ (Plot plan, showing size of lot, location of system in relatio Ao wells, b`uildings, etc, must be placed on reverse side.) NEW INSTALLATION:' (No septic tarak-or seep ge pit permitted if public sewer is available'. !thin 200 feet,) a s } *;1� S PACKAGE TREATMENT [ ] EPTIG SANK ] i Size_-------`----_--- ;-------- ------------- � Liquid Depth -------------------------- I Li Ca acct 1 � ------r-------- No P i. y -- --------- ---.-- pe :_ Material _ q Compartments Dist6hce--to nearest: ell _____________ __r___________________F,oundation --------'-- _ _ __-- Prop. Line ---- ................. LEACHING LINE No, of Lines [ ]' _ -- -y�Lengthi, of each line-------------�------------�- otal Length -----------•---•-•••-•-•---• ..-� ! D' Box ------------ Type filter Material �-------------------Depth Filter Mat• ial -------------------.-------.............__._ SEEPAGE PIT � i." 1 De the ____________ ______ iometer _______-�;--- Foundation ___-_ --------r=�_-- _ Property Line ----•-••- ........... p 1 Dista ce to nearest: 11 __________________ [ �_ p NumberL_'-_ Rock Filled Yes ❑ No i❑ ---------------- ' i- Wate ;Table Depth .•-•_ - -----_12ock Size ------:--- - g s ; - ------------------ =---------�----- --- J ) ' Date . on Prop. Line . Distance in nearest• II Foundati�l �... ---__. Septic T -, =Soni at�on Permit# -- -- ,------- ----•------------- } ( ---------------- REPAIR/ADDITION(Prev .11 c ank t(Sp�ecifyJReq ri'r ;mentsl FOR---- FnRoO{-vl--- $1=}TH DO-I I-• / J_Tf J�---` , C1 p Id-{Specify>Re }uirements} �-� QII� R �� P I C k 7--)q/N-�_ --- ��5�------ ------ Disposal Fie PDX- 'x001` = 2 '' w� AlIV E � R C-OIVA1Ec'TE� ry �3O 4= - 'f-- - -- -- _rte------ - N---- -----------------=-------------------------- - -- : ClST(Nr x '� --- ---�4'�`--�'��-SRA Dom_=�_S`.a��:1Q y-�-- - --- �I LT'��-P�=---=--- ' [Draw existing and required addition on reverse side) I hereby certify that I have prepared:this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Horne owner or licen- sed aybecoe 'ature certjk"Ffollowing: f "I cen the pera of a work fqr which this permit is issued, I shall not employ any person in such manner as toubied to n' ompensation laws of California." Signe ----------------------------------- Owner --------------------------------- .:..,�.-.� -� - Title ------------------ ------------------------- ------------------------ By _.. ( f other` than ovkrneff } -7 'FOR-DEPARTMENT USE ONLY APPLICATION ?ACCERTED BY =7771 Rt -I----------- ---------------------------------------------=------ ...... DATE ------ - BUILDING PERMIT ISSUED ------------------------------ -------------------------------- -------DATE ------------- ----------------------------- 4 ADDITIONAL COMMENT - - - ----------•------------------- ---- ----- - - ---i-----=--- ------ _- ---------------- - -----•------. ----•----__-.- . ----------------------------------- ----- y ------ ) Final-Inspec i _ _ - _ t p --== ----- - ----- ---------�`-:�.----= -�---j�Jy-fLf-• - ------------------- -- -- --- - ----- ---Date--••�-- --------- ---- SAN JOAQUIN LOCAL HEALTH DISTRICT = E. H. 9 1-'68 Rev. 5M -