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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ---- ---------r----- --------------------------------------------------------- (Complete in Triplicate)1111� _ ----------------- Date Issued _ -------- --• 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 Ordinance No. 5449 and existing Rules and Regulations. { S So P n'``� � TD 6J NSUS TRACT ---- -- JOB ADDRESS/LOCATION ------------- ; a v" Phone - Owner's Name - - ",�, �?i s- J3J ----------------------------------------- 5 . Address ------------- f' --------------------- �. - - = City --- - . ,� � 1� _License#f�- 7'� �4---- Phone Contractor's Name -_____--�_-.- - f�- ---9-zv--- �----�r�(V-- --------------- ------- Installation will serve: Residence [X Apartment House❑ Commercial ❑Trailer Court l❑ Motel ❑ Other -------------------------------------------- Number ------------------- ---- - ------------- Number of living units:-----/----- Number of bedrooms ___;+------Garbage Grinder ------------ Lot Size ------ Private 0- r - - -- - -- Water Supply: Public System and name -- -------- ----- ------ l - --- - -_ pp Y� - Character of soil to a depth of 3 feet: Sand' Silt❑ Clay ❑ Peat❑ Sandy Laam ® Clay Loam ❑ —Hardpan ❑ Adbbe ❑ -Fill-Material ----------,If yes,type---------- LL (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.] (, (P a p VI NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 240 feet,] SEPTIC TANK'[ ] S e Liquid Depth --------------=---------- i PACKAGE TREATMENT f ] --_-- No. Compartments Capacity - Type ------------- ----- Material Distance to nearest: Well -------------- - -------------------Foundation ------------ --------- Prop. Line ------._--__-- ' Length of each' Ii a,�._ { -;- ;Y e ---------------------•----- LEACHlNG LINE f ] No, of Lines t =------- ---- a t aff Depth Filter Mater. I -<=-=--=---- 'D' Box ------ -_-- Type Filter Material -------------------- p --- Foundation ------------------- i Property Line --�----------------=---- Distance to nearest: Well ___.___--__i -- -- No >I SEEPAGE PIT [ ] Depth -------------------- Diameter ------ -- ----- Number ---------------" Rock Filled Yes ❑ h Water Table Depth ------------------------- - -------- ----------Rock Size ------- ----'. --------------- Distance fia nearest: We _______________ ___ __ Prop. Line --------------- Foundation ---- .�. ---------------•- ._ Date ------- --------------------------} REPAIR./ADDITION(Prev. Sanitation Permit# -------- -------- _ _ , r Septic Tank (Specify Requirements) -_. --------- � s 1 --T/4 --- -------- ---------< ---------- . Disposal Field (Specify Requirements) ------- ------------------ ----- _ - ---------------------------------------- -------------------- ------°----------- -- -- --- ---;L;;-:------- ---- _ . .{Draw existing and required'addition on�reverse-side}-�- -- - w�----�� '�" 'X rne in I hereby certify that I have prepared this application annsthat the work will be of the San Joaquin LocaloHealth D strctnHome'towner or leeJoaun County Ordinances, State Laws, and Rules anace wh Son d Regulations sed agents signature certifies the following: arson in such manner "I certify that in the performance of the work for which this permit is issued, I shall not employ any p i as to become subject to Workman's Compensation laws of California." > ---------------------,� �-_ � -'�------ r�/� _ Owner Signed f � �----U'N - ----- - -- --•-- Title ----------------------------- - (lf other than ow er'� FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -------_:- = -- ------- - ------ --------------- DATE ------ -.1� - ------- BUILDING PERMIT ISSUED ----- ------------------ - --------------=--- --------DATE ADDITIONAL COMMENTS a - ---------------------------------------- - p -- ------------------------------------------------------------------------ ------ ------------------ -- ---------------- -- ate Fina b - - - ------ - ---- ---- D - - --- , - - - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M