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FOR OFF1Cf USE: APPLICATION FOR SANITATION PERMIT ---- --------- ---------- ---•---------------- --- Permit No. ------------------ (Complete in Triplicate) ------------------ --------------- �J Date•Issued 2- J� This Permit Expires 1 Year From Date Issued j, 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. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION --------/Q ASU- ------- -------- H ti - 172E l�Gr CENSUS TRACT . Owner's Name ------- f 1 ------ -----------------------------------------------:---- -------- ---Phone ---------------------------------- Address ---------------- I 9=--------- ----------------------------------------------- City t _.-----------------f-------- ------------=-- -----�-1---�_- g Contractor's Name ----------1111-- ---__.Licen�e Phone II Installation will serve! Residence Apartment House, Commercial ❑Trailer Court ❑ - f Motel El Other -------------------------------------- qsil { Number of living units:------- Number of bedrooms -----.___Garbage Grinder _ /rte___ Lot Size ----------!0.8-5-'--f; Water Supply: Public System and name ----------------Z:---- ---- ---------------------------------"------------------------- -------- Private +�{' Character of soil to a depth of 3 feet: Sand'. Silt:❑ ,Clay..❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ i Hardpan ❑ Adobe [] 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.) i NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) F' PACKAGE TREATMENT [ ] SEPTIC TANK [ ] Size------ w-_-� #--=----------- Liquid Depth _.�. _ ��' I Capacity 1-6-tlb------- Type __�~�_C s1 Material-_- No. Compartments ----_�_-_-_-_.... Distance to nearest: Well ----___..--6FT—----------------Foundation ___._/__r?�.__;_--__ Prop.:Line _, ------------- LEACHING LINE [ ] No. of Lines g f Length_.-- --_.. -- Length of each Iine.F._____-9.�_'-------..�_ Tota! Leng _'............... 'D' Box ------------ Typejilter Material --------------------Depth Filter Material --------t---------- .---.--------- i Distance to nearest: Well ------- ` .._. Foundation ._.__. Property Line --------------1111-- SEEPAGE P!T [ ] Qepth Diameter ________________ Number`s_..____- .. ___ __: Rock Filled I► Yes ❑ No i❑ ---------- _ WaterTable Depth ----------------------------' Rock Size 1 !` Distance to'rnearest-,-WelIT----------------------------------------Foundation --- -- ----- --Wgyp• Pro Line ------- -------------- { i REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ._..___._.._____---_-- r-_-_-J € - I -, 11. ycr `t Septic Tank (Specify Requirements)=----`-- `-------- ------------------ ---------------------------------------:--•----:-:----------------- --------------------------- Disposal Field (Specify Requirements) --------- _ �. = t `-- --------------------------- -- ---------- ---- --Y-----1111-- 1111-- ------------------------------, w -� -----------------1111-' -r:�1111-- ----------:1111-1111-- ------1111-- -------------1111-- ------------------1111-- -1111-- ------------------- ---------------------------------- --------------------------- -- ----1----------------------------------------------- ------------------------------------------------------ (Draw existing and required addition on_reverse.side)` I hereby certify that I have prepared this application and that the work will be done in aceordanie with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies thelfollow€iig: - "I certify that in the performance of the work for which this permit is issued, I shall not employ tiny person in such manner as to become sub•ec o W�m�aa� ion laws of California." Signed '1- - -------------------------------- Owner Ii -------- Title --------- -: B --- ----- - ---- -- (if other than owner) { FOR DEPARTMENT USE ONLY BUILDINGAPPLICATIOPERM TC ISSUED'BY _ _ - � DATE'__ ADDITIONAL COMMENTS --------------------------------------- "1----------------------------- ---------------------------------------------------------------------------------- - ----- --------•------- Date -� =��- Final Inspection by: --.------- - ---------------------111111 11-1111-- --111111 11---1111-- -------------------- E SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M C Pr—