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FOR OFFICE USE- APPLICATION APPLICATION FOR SANITATION PERMIT 31- 1.;3_o /-err (I -9y/ (Complete in Triplicate} Permit No: -.---_-_-----__- ---. + ---------=------------------ ---------------------------- ` Date Issued -/601�y - ------------------------------------------------------ This Permit Expires 1 Year From 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 Ordin ncjll�Jq, 49 a istin Ru�sAgn , ulatio , JOB AbDR S/LOCATIO �a; ---A-4 -4d---(9.52f-- ------ - ---------CENSUS --------------•----------- IOwner's Name ------I ----------------------------------------------------------- -------Phone fafR----60-0 ....... Address = --f- 3�--o --------�----- --.-_. City -=---------------------- --------------------------`------------------------ Contractar's Name -� _ ?'Ll� License # Phone 7�J .-6Q- ._ Installation will serve. ResidenceV Apartment House❑ Commercial :❑Trailer Court i❑ Motel ❑Other -------------------------------------------- Number ---------------------------------- ------Number of living units:- ----- Number of bedrooms --Garbage Grinder ------------ Lot Size -------------�/Z�.Q -- -------------- Water Supply: Public System and name --------------------------------------------------------------------------------------------------------------PrivateX Character of soil to a depth of 3 feet: Sand�❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam E) Hardpan ❑ Adobe X Fill Material -- If yes, type ---------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage it ermitted if public sewer is available within 200 feet,} PACKAGE TREATMENT { ] SEPTIC TANK'[ ] Size--------------------__-----._-----.---___-._-___Jj Liquid Depth - Capacity f------------------ Type , Material----------- SNP Compartments' --------------- � ll � " � �. Distance to nearest: Well �-----------------------"_�"ry-------Foundation . ---_-. ________ Prop. Line -------�_---__--_--_ p . . LEACHING LINE No. of Lines ------------------------f Length of eachlline--------- - 'D' Box --------- Type Filter 6aterial---r"r--_--_--__Depth-'Filter Material --_-_-_--_-_ ________________ Distance toy a est:.Well _--7-------_--_ Foundation -----------------------_ Property Line ------------------------ SEEPAGE PIT [ ] Depth -- ---------------- Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No i❑ 4.Wate Table Depth --_-- _ --------------------------------• --Rock Size ------- 1 C) Distance to nearest: Well ----------------------------------------Foundation .--------------.---- )Prop. Line -.-._-..__..---_------ REPAIR/ADDITION(Prev. Sanitation Permit'# -------------------------------------- Date --------------------------------- Septic Tank (Specify Requirements) ------ ` I . l Q � s Disposal Field (Specify Requirements) - ## ------ i ------------------------- --- --- ------ - t - �`� 1 - ---------------- - `� _ Draw existingand required addition on reverse side) f hereby cerfi'rfy that E'hava p�epa d"this application gnd-that_the work will be done in accordance with'San Joayui.n County Ordinances;State Laws, and Rules and Regulations of the. San J ao quin Local"HealthDistric Home owner or liven- sed agents signature tertifiets'tWe',Wlowing:�0 ` "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 Workman's Compensation'laws California." ll Signed -------------- -------- ---------- -- --------------------------- Owner BY -- ------ - r - - ---------------------------------- Title ----- -------- ° (If other owner) I FOR .DEP RTMENT USE ONLY j APPLICATION ACCEPTED BY ------------------------------------------- DATE -`t3�' BUILDING PERMIT ISSUED ---------- -- ----------------------------------------------------------------------- DATE ------------------------------------ ------ ADDITIONAL COMMENTS - ---------------------------------------------- ------- --------------------------------------------------•------------------------------------------------------------------------------------------------------------------------------------------------------ i --------------------------------- ---------------------------------------------=- ----------------------------- -------------------------------------------------------------------------------------- '�-------------------- _ ----V%1 ----- 1 ..- f Final Inspection b -------- - ---------- -- ------- - - P Y �, F� r �`k 1 -------- ------------------------- Date �� SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M ; f