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FOR OFFICE USE., APPLICATION FOR SANITATION PERMIT Permit No. - ---- ------ ------ ---- 4----- ---------------------------------------------------------- (Complete in Triplicate) Date Issued -- ----- -- ---- ------------------ ------------------------------ . .... ----- -------I This Permit Expires 1 Year From Date issued 053—0 - - -- ------------------------------------- ------------------- to construct ancl L��tal?Ate work hereilt y made to the San Joaquin Local.Health District for a permit ing Rules and Regulationst Application is hereby with County Ordinance No. 549 and exist i -A,& s application-is.-made in compliance descril.Ded. Thl! -------------------- ------ -CENSUS TRACT - --- - ------ JOB ADDRESS/LOCATION�14 ----- --- - --- -----Phone ------------------------------------ ----------- ------ owner's Name ---------- ---------------------------------------------- 0 city..--------------------- Address ------------ --- - ---------- e JJ AAOJ _ Phone ----------------------------- ...AW~ . License Contractor's Name ------- --- -- -- sidencJ partment House[] Commercial�F�Trciiler Court 0 Installation will serve-. Motel ❑ Other -----_�7 LotSize -------------------------------------------- �N Number of living units:-------I---- Number of bedrooms _7�...Garba-ge Grinder L---------------------------------Private — _ - --- —---- ---- ---------- - Water Supply: Public System and I name -------------------------- -----C-la-y---E]-----Peat❑ Sandy Loom -El Clay Loam.[.I ter of soil to a depth of 3 feet-. Sand'[] Silt[] -------- Charcic Fill Material Hardpan [( Adobe El a ------------ If yes,type -------------------- n to wells, buildings, etc. must be placed on reverse side.) (plot plan, showing size of lot, location of system in relatio. ge pit permitted blic sewer is available within 200 feet,) see 00 ------IV----------------- NEW INSTALLATION: (No septic tank or se Size_ la{ ----------------- Liquid Depth PACKAGE TREATMENT SEPTIC TANK[i �_1a U,,_4---f-"13 nts ------- i 1.9c --; -Mciterial ----- No. Compartments Capacity 1-6-4e- Type ' Foundation -------f-6---------- Prop. Line ---- Distance to nearest- Well ------- 6',0 ------ Total Length ------ o------------------ ej LEACHING LINE [Aof No. of Lines ----------&2---------- Length of each line Zia,--- ep Dth Filter Material ---_/!P----------------------- ---------- 'D' Type Filter Material ----------------- JO I- ------ I tion ....... ----------- Property Line. ------- ...... Distance to nearest: Well ---------- --------- Foun'da yes No C] Diameter Number ------------&------------- Rock Filled Depth ...... SEEPAGE PIT ----------- ----Rock Size Water Table Depth ----------------------?� k f �l - Foundation ------1-19--------- Prop. Line ------ ------ ....... Distance to nearest.. Well --------------/!��!............;------ :i REPAIR/ADDITION(Prev. Scnitction ermit# --------------------------------------------- Date -------- ------------------------- I -----------I---------------------------- I -----------------------------------------------I-------------- Septic Tank (Specify Require.Lntsl -------------- --------------- -------------------------------------------------------------------- Disposal Field (Specify Requirements) ------------------------------------------------ ------------------------- I --------------------------------------------------------------------------------------------------------- -------------------------------- ---------------- ---------------------- ------------ --------------- -------------------------------------------------- ----------- i. -------- -- - ------------------------------------------------------------Draw existing and required_a_61_4i_ti o--n----on reverse side) I hereby certify that I have prepared this application and that the work will Localn ibe doHealth District.ne in accordanHome ce witowner or licen- h Son Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin sed agents signature certifies the following- k for which this permit is issued, I shall not employ any person in such manner "I certify that in the performance of the work as to become subject to Workman's compensation laws of California." Signed ----- ------------------------------- --- ---------------- Owne ------ Title ---- ---------------- ------------- -------- By ------------ ----------------------------- (If other than owner) FOR DEPARTMENT USE ONLY DATE ------2-6--------------- ----------------------------------------------- -------- APPLICATION ACCEPTED --------------------M--------------DATE ----------------------------------- BUILDINGPERMIT ISSUED ----------------------------------------------------------------- --------------------------------------------------------------------- ---------------- ---------- ----------- -------------- ADDITIONALCOMMENTS. . -1------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------- - ---------------------------------------------------- -- --------------------------------------------- ----------------------- ------------------------------------------- ------ ------------- -------t------------------------ ------------- --------------------------------------- -------------- ---- ------------------------------------ ---------- -------- ------------------------------------ - - Date -- -- --------------------------------- --------------------- Final Inspection by: _?----------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.