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APPLICATION FOR SANITATION PERMIT FOR OFFICE USE: ------------ Permit No. _5 - (Cornplete in Triplicate) ---------=---------------- ---------------------- {" Date Issued ____ ___"-"""__"________--""" -This Permit Expires 1 Year From Date Issued I t 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 Cdunfy�"Ordinance No. 549 and existing Mules and Regulations: JOB ADDRESS/LOCATION. .. �_ V 5 157 -_j�' ' `--------- C`- --- ---CENSUS TRACT ----- ----------------- - _ f �r Owner's Name � ��[---------PR eNMA V------------------- ----- -------- ----------Phone Q } 4 Address f :F � -`---------5- "' . -------- ` City G 1, � 4 E 1 —---' - License # ---------:------ ----_- Phone ----------•------------------- Contractor shame---__-" �--� _-:��--------�---- - Installation will serve: ResidenceAparfiment l louse°❑-Cainmercial:[Trailer Court 1❑ l Motel ❑ Other -------------------------------------------- Number ----------------------- ------------------Number of living units:-_-�______ Number�of bedrooms 1--- Garbage Grinder IV ---- Lot Size __!;-RJE_6 ------- Water Supply: Public System and name ---- -=_`---------------------- ------------------------------------------Private Character of soil to a depth of 3 feet: Sand' Silt E] Clay ❑. ,Peat §Y�ndy.Loam E]- Clay.Loam:❑_ �___ ` Hardpan 'Adobe E] Fill Material -I��_``',If yes, type ____---__----------------- i t (Plot plan, showing size of lot, locaticntof system in relafion_to wells, building s' etc. must-be placed on reverse side.) NEW INSTALLATION: (No septic tank or.seepage pit-permitted-if.-public-sewer'is'available within 2QQ feet,) PACKAGE'TREATMENT [ ] SEPTIC TA14K I ] Size--------------------------- ------ Liquid Depth -_------------------ ----- r„f� Capacity ----------'' `: Type-----------------1--11Ma`erial --------------------- No. Compartments ------------_------- Distance: to nearest: Well -----------'------------ ----'-----Foundation ---------------------- Prop. Line _.---------------_-. LEACHING LINE [ ] No. of Lines ____-___ ' Length of each line ---------------------------- Total Length ________--_.__________-__-__ i. �.)I i k- ' D' Boxy'_-- ----Type Filfer'Material --------------------Depth Filter Material ------------------.---------------------•- r Distance to nearest: Well _._'_____________________ Foundation -______------.-._______ Property Line ____._________---.-__-- SEEPAGE PIT [ Depth --------------------I Diameter __ _____________ Number' - ------------------------ Rock Filled Yes ❑ No-C] Depth Water Table ' p h - ------------------------ -------------Rock Size ----------------------------- -- + ; I 'Distance to nedrest: Well ________________________________________Foundation --------------------- Prop. Line -------------------- REPAIR/ADDITION(Prev. Sanitation Permit# ------------ -------------- ---------------_-Date _______________________________---} SepticTank (Specify Requirements) ------------------------------------------------------------------------------------------------------------•---------------------------- L - Disposal Field (Spei:4 Requirements} ---D)$T ----04?k .°F-----•7✓5'_------ ��{1Cj�--:-.LrN.�__�-----1-------Pr"7 ---------- _x. --- --------------------- R¢. ,-.� 1-« - ---------- ct, 1 (Draw existing and required addition on reverses " "" I here b certi that I have prepared this application and that the work will be don Y fy , p P done in, accordance with San Joaquin i County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents's'ignature certifies the following- "I certify that in the performance of 'the".work for which this permit is issued, I shall not employ any person in such manner as to become subject,to WA kman's Compensation laws of California." Signed Owner ------------------ -Title -------- --------------------------- (If other than owner) �^ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY . f +--�----------------------------- DATE ------ BUILDING`PERMIT-ISSUED" r� --,:_---- �==` - _ _ - �--- --- �_'-. .. -- DATE. : .:. - ------------------------ ADDI710NAL COMMENTS -`' �- ,'` ".__- _ __------``s- `°`'-' --- ------------------------- ------- ..: .._ _.- _ ..-.. __ - � - ----- .. ._ _- --- - ---------------------------------------- ----- --------- --- Final Ins e ----------------------------------------------- ction --- - -------- ---- ----------Date _.--- � = - p '�,� - ------ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H._9 -. 1-'68 Rev. 5M