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FOR OFFICE USE: APPLICATION FOR-SANITATION PERMIT permit No. - R ---- --- ----- ------------ (Complete in Triplicate) ---------------- Date issued ---------- ------------------------------- --------- This Permit Expires 1 Year From Date issued County Ordinance No. 549 and existing Rules and Regulations- App' egulafiions: App'+ca tion is hereby made to the San Joaquin Local HealthCou District for a permit to construct and install the work herein described. This application is made in compliance with Y CENSUS TRACT JOB ADDRESS/LOCATION ._�._ �-7--�--1--- -- ---- ----- --- -Phone ------------------------------------ s -- ------------------------•------- Owner's Name - ` }----�.--.- - _� - ------- -- �j '�a�c t ? Cit ------------------ Address - �: r Jr f Y- Phone - i � License # _1 .3 Contractor's Name se Commercial ❑Trailer Court i❑ Installation will serve: Residence [B-Apartment.-House❑ 'Motel ❑ Other - ---------------' ✓ `� = ---- > -_----Garbage Grinder�------- --- Lot Size ----------- - - --• .,.. Number of living units:.- .- ----- Number of bedrooms _ private :• . Water Supply: Public System and name --------------------- Clay Loam ❑ Character of soil to a depth of,,3 feet: Sand' ❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Y Hardpan F] Adobe'El --.Fill Material -'- ....... If Yes, type ---------. f (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. musfi be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit per if ublic sewer is available within 200 feet;) �� � Liquid Depth --- ------------------- PTIC TANK:[q----,- PACKAGE TANK:[�1 ---- ------- ----- PACKAGE TREATMENT [ ] t ; a --- Material-- � -- == No. Compartments ---- Capacity:`-1 G? yPe -. , �' Foundation - � .__�-------- Prop. Line Distance to nearest: Well ---------- � h LEACHING.LINE [ No. of Lines -__..- - Length of each line--------f---`'---------:-- Total Length' ,--• 'D' Box --4 Type Filter Material --�- Z-:_-_-.Depth Filter Material -----C -- r ' Distance to nearest: Well .._--___ -- Foundation ------ L €?-- ---- -- �-e-------- Property Line - it a4 -- - Rock Filled Yes ©' Q 0 --__ Number --- --- SEEPAGE PIT [.'� Depth -2 5----- Diameter Rock Size �- l�-------------------- Water --—-------------- V i / o Pro Line ----------- ---. Water Tabie Depth Foundation ------------- `��, Distance to nearest: Wel _- D a j Iry REPAIR/ADDITION(Prev. Sanitation Permit# ----- ---- --------------------------------- ----------------------------- Septic Tank (Specify Requirements) ----. --- ------------------------------- �A- Disposal Field (Specify Requirements) ----------- ------------------------------------"-- - - -------------- -------------- - --------- ------ -- -- -------------------------- (Draw exist'sng and required addition on reverse done in h Son Joaquin i - ce /IC he-reby certify that f have prepared this application and that, theea ork Joaquin Local Health Dis will be County Ordinances, State Laws, and Rulestr'�dCtnHometowner or I cen- and Regulations of t sed agents signature certifies the following: erson. in such manner "I certify that in the performance of the work for which this permit is issued, I shall not employ any p f California." as to become subject to Workman's Compensation laws o Owner ---------- Signed -------------------------- ----- --- ---fi Title ----------------- ------r- --- � U ------------ i (If other than owner) f FOR DEPARTMENT USE ONLY / DATE ----- -r--7-1--------- '.: APPLICATION ACCEPTED BY !, "'' ------------------------- DATE -. - ---------------------------_-=- BUILDING PERMIT ISSUED ------ ------------------- ----- ----- ---- ---- `ADDITIONAL COMMENT ------------ ----- ------ - --------------------------- I --------------- - ----- �� __ - = _ 7� _ _ __ -_� ' -- ---- -- ---- ------ --------- ----.------ ----- ----- --------- Date - - -- -- - Final Inspection by: - ----- ' ��" _`�`w; --- SAN JOAQUIN LOCAL HEALTH DISTRICT ' 1. E. H. 9 1-'68 Rev. 5M