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rVR OFFICE USE: - --- -- --- --- -- � - �-- --- ---------- -------- APPLICATION FOR SANITATION PERMIT -- -------------------_______I_ _____ (Complete in Triplicate) Permit No: This Permit Expires 1 Year From Date issued Application is herebyq Date Issued described. This a made to the San Joa uin Local Health District for a application is made in compliance with County Ordinance No. 549 and existing Permit to construct and install the work herein JOB ADDRESS/LOCATION ----- ~' ��}�.Q-"-,-� ! � ,-� g Rules and Regulations: Owner's Name ---------- _ � G� UQ--------- c- 121 --- CENSUS TRACT Address __.---- � --•--------------------- ------•--- - -- -- ..------ -- -- ------------ Q--�-�--�?----- -- -- - - ---Phone=$31- Contractor's Name -- ------- '--, _ ------- City -12K�C.` -------- Installation ---------------------------------------------------------•--- Installation will serve: " --" --- """ -�--"�------------ - - - � _ Residence License # -3)-5G S_ artment House� ------ Phone _�t/�_.� S S"-- _• ❑ Commercial❑Trailer Court i❑ Number of living units: N Motel ❑Other------------------------------------------- ---- umber of bedrooms ----- Water Supply: Public System and name ------------ ----Garbo ; Water Supply: Public System and name _-___ 'Vp - - - --------- ------ Lot Size ----�-�_... Garbage Ander _ --------------"-"-- Character of soil to a depth of 3 feet: Sand ----------------- ----- -- ----Private Silt� Clay ❑ Peat " - - -----•----- Hardpan ❑ Sandy Loom .❑ Clay Loam,0 ❑ AdobeX. Fill Material ------------ if es, (Plot plan showinY type ----- ----------------- g sizeof lot, location of system in relation to wells, Buildings, etc. must be placed on rNEW INSTALLATION: ( o septic tank or seepage it PACKAGE TREATMENT p permitted if public sewer is available within 200 feet,} reverse side.} [ ) SEPTIC TANK Q\ s�,�__ Size � � Capacity _f�?.r9�-- ----------- Liquid Depth -----�-�-Z---- Distance to nearest: Well ype _P CI - Materia�__Coc rte"---- No. Compartments _,___ LEACHING LINE Foundation -----�-�- 1 No. of Lines ------ Prop. Line ------"-------- Length of each line.--_8Q 'D' Box .Ute-5--- T Tota! Length Type Filter Material _ --Depth Filter Material 1 ` 'Distance to nearest: Well ____ _�-------------- Foundation -----------------------------_- SEEPAGE t ) Depth �..Pro erty Line. a`�_V ------ -------------------- Diameter - Water Table Depth ......... ---------------- Number -.-----------------_" ------ Rock Filled Yes .0 No -------- ----- Rack Size . Distance to nearest: Well --------------------------------------- ""-- REPAiR/ADDITION(Prev. Sanitation Permit# ____"_- Foundation t ----------------------- Prop. Line ,---------- ------- Septic Tank (Specify Requirements) _"-" ate ----------- -- ) Disposal Field (Specify Requiremenfis) --- ----- -------------------•- -------- ---------- ------------------- ---------------------- F ------ (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 County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local done District. H sed agents signature certifies the following: with San Joaquin "I certify that in the performance of the work for which this permit is issued, 1 shall not employ Horne owner or licen- as to beco subject to orkm n's Compensation laws of California." . ,] p y any person. in such manner Signed - =[lln.�---- V'- � ► 6 - -------------------------- ----------- ----- Owner (!f other than ---------------------------------------------------------------------------- Title FOR .DEPARTMENT APPLICATION ACCEPTED BY USE ONLY BUiLDING PERMIT ISSUED ----------- _- --I-~ ADDITIONAL COMMENTS .----------- -`'- ----------- DATE ----------- ----- -------- --- - ------DAT ----------------------------------------------------------------------------------------------------------- --- -- ---------- ---- ----------------------------------------- - -v- ---------------------------------------- ----------------------------------------------------------------------------------- lal Inspection b -- -- ------------- ----- - - -- --- --- - ----Date --- =�� _-----------------j------ �' SAN JOA4 IN AL H L ICT 1-'68 Rev. SM. i