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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 'gw wle �' Permit No: ------ ;k ip ---------------------- (Complete iri Triplicate ------------------- Date Issued/,� ------------- ------------- This Permit Expires 1 Year From Date issue l the work herein Application is hereby made to the can compliance with CouJoaquin Local Health ntytQ dinarict rnce No. 549 and existing Rulestand Regulations. described. This application is mad '� P / _CENSUS TRACT -------------- ----------- JOB ADDRESS/LOCATION -.�? ------ / -- ------- ---- U G� � ` -----------Phone ------------------------------ Owner's Name - --------------------- Cit �d-L---- Address --- - -- - -----�/ ---------------------------------- Y ` License # /- --------- 11)9Phane Contractor's Name ...__- -E-- c-. � ------- - Installation will serve: Residence % Apartment House❑ Commercial ❑Trailer Court 0 I Motel ❑Other ---------------- --------------------------- LotSize --------------------------------------------- Number of living units------------- Number of bedrooms .. Garbage Grinder ------------ private ❑ Water Supply-. Public System and name _---------------------fl pp Y� Y ---_•.__-, Peat Sandy Loam ❑s " Clay,Loam;❑ Character of soil to a depth of 3 feet: Sand Silt Cloy ❑ ❑ 1 Hardpan E] Adobe'[] Fill Material if yes,type ---------------------------- Plot lan,.showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) pp ( P Aa NEW INSTALLATION: (No septic tank or seeps a pit permitted if public sewer is available within 200 feet,) SEPTIC TANK'[ Size �. &-J-------------------- Liquid Depth --� - ---•---. PACKAGE TREATMENT [ ] _ No. compartments _ Capacity - ------------------ --------------'---- Material--------------------- p . , I----- -- ---- -- Type � Distance to nearest: Well -------------------Foundation --------------- Prop. Line --_tiO-=--= � _.-- Total Length !-�_`3------------------- LEACHING LINE [ ] No. of Lines -__--� _------ Length of each line--------------------- ' - . ! - _-/� Depth Filter Material ----- - ---- y --•-. D' Box ----- Type Filter Material cS� °=`� 71 f- D t Properly Line. ------------- Distance to nearest: Well ----- --------- _. ____ Foundation -_ ------------ --- ----- - Yes C] No ❑ SEEPAGE PIT [ Depth Diameter _------ Number -------------------�------- Rock Filled ------ Rock Size Water Table Depth - Pro Line -----------•------- Distance to nearest: Well ------------- Foundation --------------- P TDate ----------------------------------) , ` ! 1 REPAIR/ADDITION(Prev. Sanitation Permit# ------- NPtV 3j Se tic Tank (Specify Requirements) --- - +` --- p ----------------------- --- Disposal Field (SpecifyRequirements) -1-46----------- -- ---------------------- --------------- -- i ---------------------------------------------------- ---------------- ----.--------- -----ng---------- -------------------------------------------------------------------------- -------- -"---- - -- (Draw existiand required addition on reverse side) I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquinr livn County Ordinances, State Laws, and Rules and Regulations :of the San Joaquin Local Health District. Home owner or icen- f sed agents signature certifies the following: "1 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 of California." Signed ----- -------------------------- Owner - ---- ------ - ------- - ----- ` Title -------- -------------------------- ----------------------------- -- --------- If other than own FOR DEPARTiAENT USE ONLY DATE - - ---Z/��----G - APPLICATION ACCEPTED BY - ------------- DATE - 7-----�- BUILDING PERMIT ISSUED = �� _I� AD�?iT ONAL COMMENTS _- `'`"� ��--- ---' �� -� - - - c d -------------------- —X �--_ " . - -~3��.� -`,� --------- ------- -- ----------------------- --- � --------- ------ ------ -------- ------------;- ---------Date ----- Final --- � ---- ------ ------- ------------ Final Inspection by- --------------------------------- ---------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT , E. H. 9 1-'68 Rev. 5M