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OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit'No: ' ------------ ------ (Complete in Triplicate) ----------- --------- ;p A t Date Issued This Permit Expires 1 Year From Date issued --•-----•... ................ )tion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work I ed.This application is made'in compliance with Co Y Ordinance No. 549 and existing Rules and Regulation r •..j.�.A �J'f ' DDRE55/LQCATION . L �a t+ ' CNI � � � CENSUS TRACT _` __. s Name y. _ .- t� -. - .............-- Pho a fz4 15��_ .._ City .:.. S (+ rq Qeos� ' F!Sse,.License3:rX#Phone ' dion will serve: 0 Residence Apartment Housep Commercial:QTrailer Court t❑ Motel []Other ----------- -------- ------- .............. r of living units:......... Number of bedrooms A.�-•--Garbage Grinder ............ Lot Size ................................... . --- Supply: Public System and name ........................................--------- ---------------------------------------- •�..... ---Private'' _ ter of soil to a depth of 3 feet: Sand 7] Silt❑ Gay ❑ loomw y loam.❑ Hardpan E] Ma Ado b Fill terial Q-I__.._SaIf Yes,type .-- ----- ............. Ian, showing size of lot, location{ of system in relation to wells, buildings,-etc, must be placed on reverse VSTALLATION: (No septic tank for seepage pit permitted if public sewer is available within 200 feet,i r/ ,GE TREATMENT ( ] SEPTICTAN V�� Size.3�?� --.Q-+ ....... Liquid Depth,.- -- ^IfiL 0 CGL.. Materiah - No. Compartments ..... ' Capacty � .._.__ TYPe Distance .to' naresT: Well .. p -- - Foundation ......./.-Q.-�-__ e ....... - Prop. Line ' ti Length of eadi line_....e Q• ......---- Total Length ,.---�• -e ' ING LINE M No. of Lines ..... - _ c �--•-• ..- �' ff�� De th Filter Material --- 'D' Box ..Y!_ ..... Type Filter Maria{ - - - P e ,T • - i, .I iFa ation _� ICY .� /f�..._ Pro Line, ._. ---.. ' DiStanCB t0 neafeSt: WBII�:7-r/--.-_:._ .._. eR ". ' GE PIT [ ] Depth _ Diameter 'y.__------- Number..............•----....•------ Rock Filled Yes �] I Water Table Depth ..----------_: `_...._.__.... v RSckS[ie ..................... ..._i 1 / .....Foundation t......__.......... Prop. Line ........ ' Distance to nearest: Well .___....:........_....__�..._. ) + n F. Date ...._.......�....... ' - R/ADDITION(Prev. Sanitation Per.mit#'-"-:•••---••----•--•--..... + ..........._...__. - . ........'rte .........- tic Tank (Specify Requirements) 3osol Field (Specify Requirements) .............:..._. ....----.................... -,----••---- ............. - ' (Draw existing and required bdoltion on reverse side) by certify that I have prepared this application and that the work will be done in accordance with San J y Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner e ' tents signature certifies the following: ermit is issued, I shall not employ any person in such tify that in rhe performance,of the work for which this p bec blest to Wo kman Is Compensation laws of California. s ' - Title ...----.-_...........................<---•----------'----.._.._..._.._ (If other than owner), 1 FOR .DEPA MINT USE ONLY CATION ACCEPTED BY---- - - - •-------.....................•---•---------•--......._.. DATE ". ' �. L .... )ING PERMIT ISSUED-- ......!...... ....... .....---....... ......---..._.-...._....------...........................DATE-------------•------- -.. TIONALCOMMENTS .......... ..........•--•----_......_......._.....•--_...•-_-.......................................•-----...._._.........•................ _... .......................-------------- _------.--------------------------------------- --:' ...... ... ........ 70 ... •...................--............._....._....•...... D -1 .---- ------ ---- _ ------ 6 Inspedion Y- ' E SAN JOAQUIN LOCAL HEALTH DISTRICT � s i 9 1•'68 Rev. SK _