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APPLICATION FOR SANITATION PERMIT Permit No. -�-- -`--• FOR OFFICE USE: j Sete in Trlplicate) in ------------ltCompDate Issue------------ "This-Permit Expires 1 Year From Date Issue j ere permit to construct and 'install the work ',.. .. . Rules and Reg uin Local Health District for P . ) Application is hereby made #o the San �oaq V4ance with County Ordinance No. 549 and exist;ng i � desenbed_ This application is made in comp• _ CENSUS TRACT_-.- ---- --------"q"""" " _.Phone 1.?�-•/ 1 ----- •--- JOB ADDRESS/LOCATION . ---- ��Q Owner's Name ? z-_. / , _ -- - '�° License # ----- IV ----------- Phone Address -{------------- _ ____ -- - --- -- -- ---� - -- "- Trailer Court '❑ Commercial Residence❑ p r Contractor's Name --------- - p, artment House' Instaliation.wwil erve: ' Motel ❑Other Lot Size Grinder " ❑ Garbage Private 4 �`� units:_--�------- Number of bedrooms _- ---------- �2 t --- Number o livin=gClay'Loam i 1' Public Systeand:name ---------------------------------------------------------- npeat❑/ Sdndy Loam • t Water Supp Y,P .", 5i1t❑ CVay ❑ �/ kf yes,type ------------------------ Character of soil to a depth of 3 feet: sand' FillMateral - ------- (� 4 Hardpan ❑ Adobe'❑ - 4 s etc_ must be placed on reverse side.) ' stem in relation Ito hw Ils, building `' size of lot, location of system public sewer is available within 200 feet,) 4 (Plot plan, showing , seepage pit permitted i� f pub Depth -----------------------•- s tic tank or -_ ---- Liquid NEW INSTALLATION: {No sept 7Size------------------- - ' .SEPTI�NK'[ 3 --__ No. Compartments 4 PACKAGE TREATMENT ( 7 J"-_-- Mater9al �-- ' Capacit�'` Type Prop. Line Y - / :F.oCrhdatian -- - r ---------------------------- t --_�-�=--""it _ Total Length Distance to nett S '. eVl -' �.. ..�-- •_.Length of each line---------------------------- No. LINE [ ] No• of Lines --- -:_- --- - ,- __--"_pepth Filter Materia ------------------------------------------- r -------- -r ,,.Type Filter Material ------ Line. ---------•--------•-•- 'D' Booxx, --- Property Foundation --- --- --- ------ --- - -------"-_- Rock Filled yes '❑ No 0 P. Distance to nearest: Well ---- NumbeS Depth -------------------- Diameter-„_� SEEPAGE PIT L�) t Rock Size - - q, I_r�� Water Table Depth ------------------- Prop. Line l Foundation _. Distance to nearest: Well ------ - ] i . I . � ----- --- --- ------- ---- pate ------- -------------- -- ---• - o REPAIR/ADDITION(Prev. San�tat4on Permit ----- -------------- ' Septic Tank (Specify Requirements) ----- I ----------------- } S ecif Requirements) - 4 Disposal Fiel ( P Y 4 t ' ----------------------- - ----- ------ --------------- ----------------------------------- --------- -�uiied add-ltio o feverse'side) _-_"----------------- -=-- - (Draw existing and req {kation and that the work wi{{ be done in accordance with San Dago that I have,prepared this app - 4 1 hereby certify Rules and Regulations of the San Joaquin Local Health District. Home awns+ -or rcen- County Ordinancesr State Laws, and I shall not employ any person in such manner sed agents signature certifies the followings „ erformance of the work for which this permit is.issued, 1 certify that in the p ensation laws of California." as to become subject to Workman's Comp Owner ----- Signed __'_------ ---------------------- ------ Title owner)� BY -------------- - (if oer t FC►R--DEPARTMENT USE ONLY `/—Z �-_-�.�-- - --- ---•-•---- -a x DATE ----7--- - `------------------ --- RATE ------------------- _ APPLICATION ACCEPTED BY -----=----- -- --- ------------r6----------------------- ---------------------------------- ------------ ----- BUILDING PERMIT ISSUED ----------- ADDITIONAL COMMENTS :- ------------------------------- ----------------: ----------------------------------------------------------------------- ------- --------- - -- ----- _ ' r ---------------- - iY Date ----- - ---------------- ----- - - - -------------------------------------------------------- ------ ------- - ----- - - ---------------------------- Final ------ ---Final inspection by: ---- , SAN JOAQUIN LOCAL HEALTH DISTRICT u v 1-'68 Rev. 5M