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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT �{ � ---------------- - Permit No. �--�--_-�--� d (Complete in Triplicate) - --------------------------------------------------------- _____________________________-.____.__.___----_-------- This Permit Expires 1 Year From Date Issued 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: JOB ADDRESS/LOCATION .=__`f -J fly__ Pl � _-__ R_r ------------P --- --------- ----CENSUS TRACT ------- Owner's Name ....... ------ _ ARK . -------Phone Address f ._J _ //1lCat L/ ----------------------------- --------- City ---All -------------------- Contractor's Name --M�R P_i`# S_-- / f : J _.License # ------------------------ Phone --------------------------._._ Installation will serveResidence ( Tartment House�F Commercial ❑Trailer Court i❑ Motel ❑Other -------------- ----------------------------- _ Number of living units:-.-f_y_._ Numb roof beWo ms _ Garbage Grinder _ Lot Size __ Water Supply: Public System and name ------- __ __-Private ❑ I Character of soil to a depth of 3 feet: San Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam E] -- , Hardpan ❑ Adobe-❑ Fill Material _ '._ If yes, type __________________---__-_- (Piot plan, showing size of lot, loc6tion1,L:gf system;in kFelation to wells, buildings, etc. ust be placed on reverse side. NEW INSTALLATION: i 1,(No septic tank r sbepdge`pit perm.idled if public sewer is availa le within 200 feet,) W PACKAGE TREATMENT I [i]'l SI=PTIC TA '[ ] Size_-- --_ _-•_-•- .-, ;------- ---- Liquid Depth ------------------ -------- Capacity -- v Capacity ----`-`.-- - ""--- Type ------------ --------?Material-----------------4--- o. Compartments - P Distance to nea st: Well ---------------------'--------------Foundation(------ --------------- Prop. Line ---------------....... e. 6 i , LEACHING LINE [ ] No-.! of Lines -_ ` --------------- Length of each line_ ______ ------ __ Total Length -_ ___.___,---_.-___-______ I 'D Box ---_-------- ape Filter Material ------ -------------Depth Filter M terial ----------------_--------------------------- Distance to Weare t:'Welli__ """_:__________ Foundation Property Line ________________________ SEEPAGE PIT [ ] Depth k-------------- -- Diameter ---------------- Number ._-------_---- ----- ----- Rock Filled Yes ❑ No --`--7 ------------ f-- Water Table De� ---------""""-- --_""_---Rock Size � --------------------- Distance to Weare fi Well 'f`____________________________________Foundation --- -------------- Prop. Line ---------------------- I it Sanitation Permit -------------- '---� IDate _ Septic Tank (Specify Requirements) _kN. Disposal Field g(Specify Requirements) -- _ - _�_�_G�------ -- -1V - --- ! -- I ----------------- - _ , l -------------n�� _ 40F._------- ------------ 'RD r4A�__---- _ R ------------------------------------ (Draw - , fl t _ --------- - ----------- r = - -_ existing and required addition"-ori 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, ands Rules and Regulations of the San Joaquin'Local-Health District. Home owner or licen- sed agents signature certifies the following: "I certify t i he mance the work for which this pei7nit is issuedhall not employ any person in such manner as to be a je -Compensation laws of California."Signed -- ----. Owner V.,t ' I B - ifle c ---------------------------------- ------------------------------------- [If other than owner) [ FOR DEPARTMENT USE ONLY BUPDINGOERM TC SStI�DBC4 ` 'kT -� '-n-`-_ �C€'' _ �" :: ` ` *��--------------- DATE ----6- F�-_17= = -- DATE -- ------ ------- ADD.iTIONAL..COMMENTS` ---` [ --------------- - ------------------------------------------------------------------ -- - ----------------------------- [ -------------------------------- -- ------------------ ----------------------------------------------------------------------------------------_-_-_-_--_---i------_-----.--- ------- ---- ----------------- --------- - ------ ------ t Final Inspection' y: ._ --------------- -------------------------------Date ----- ---_ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M