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FOR OFFICE USE: - �pPPLICATION FOR SANITATION PERMIT q-Permit No. ; -- - -- ---- ...... (Complete in Triplicate) Date issued - This Permit Expires 1 Year,•From Date issued with County Ordinance No. 5.49 and existing Rules and Regulations: Application is hereby made to the San Joaquin Loecal,Health District for a permit to construct and install the work herein PP application is made in compliant described. This app ' I ---CENSUS TRACT /✓ JOB ADDRESS/LOCATION -� '-. a-s - _ ------=- ---- -Phone -------------------------------- Owner's Name ------------ --- City -,!g-7-1,c-77------------- ------------------------------ ----•- Address --------- 517A'5�------ ---- ------------------------------------------- 1�{rte-- -s,�s�-- ---- ---- ------ -------------------------------- License # /77- Contractor's �]-7Phone��1�'�----b---- Contractor's Name _. _. _. Commercia Installation will serve: l ❑Trailer Court C1 + Residence [p%Apartment House'❑ r' �"', Motel El Other -------------------------------------------- -0---- ----• 3 Garbage Grinder / Lot Size -a!��- Number of living uriits ._--( - Number of bedrooms _- ___-"-- private ❑ Peat❑ Y Water supply. Public System and name --------------------- --- Sand Loam ❑ Clay Loom El Silt❑ Clay ❑ �, Character of soil to a depth of 3,feet: Sand`❑ e - ------------- Hardpan ❑ Adobe [- Fill Material If Yes,type z of lot, location of system in relation to wells, buildings, etc, must be placed on reverse side.) (Plot plan, showing si e NEW INSTALLATION- . i(No septic tank or seepage pit permitted if public sewer is available within 200 feet,) ,. - Size Liquid Depth PACKAGET-REATMEN7![ ] 'SEPTIC TANK,t ] - Capacity --. ---- Type --- ---- ----- ---- Material------------- ----- No. Compartments Y Distance #o nearest: Well'-------------- �--- ----------- ---Foundation .------------ ------ - Prop. Line _j_-"-------=-------- I i ength /1/1 No. of Lines ----�- ---------- Length of each line--------------------------- Total L .-771'------------------------ LEACHING LINE [ I ---- + I Depth Filter Material -------------------- ------------------------ D' Sox _-----. -- Type Filter Materia -------------------- { Property Line, - - - - ---------- pistance�to nearest: Well -,MAY+-� Foundation Rock Filled Yes ❑ No10 Depth --------- Diameter ---------- Number ------------ ----- EPAGE PIT L l P ,t �---- Water Table Depth ---------------------------------------- Rock size ----------------------------------------- Distance!to nearest: Well ------------- ------ -- ----------------Foundation -- ---------------- Prop. Line ---------------------- Date ----------------------------------) REPAIR/ADDITION(Prev. Sanitation Permit# ------------------- ___._- --- ---------------------- 'i Septic Tank (Specify Requirements) ------------------------------------ ---------- - ku,I-r&----/`�--- 1 �7 *D- D n_ Disposal Field (Specify Req! _ irements) --l.0- -1—(-� --- ----------------------- ----------------------- `aT -- ------ -- ------ ----- (Draw existing and required addition on reverse side) ne in ce with Son Joaquin I hereby certify that I have prepared this application and that}�$San Joaquin Localwork will be sed District. Ho e owner or liicen- County Ordinances, State Laws; and Rules and Regulations o sed agents signature certifies the following: ermit is issued, I shall not employ any person in such manner "I certify that in the performance of the work for which this p as to become subject to Workman's Compensation Paws of California." Owner Signed -. -------------------- ----- - Title --------- ---- ----- - - ---- � (If other than owner) - FOR DEPARTMENT USE ONLY DATE _ FX- ----------- ---------- APPLICATION ACCEPTED BY ----------- - - { DATE ------------ BUILDING PERMIT ISSUED --- --.--------==-------------------------------------------- --------------------- ADDITIONAL COMMENTS -------------------- ------------------------------------- ----- ---------------------- ----------------- ------------- ------------- ------- - ---------------------------------------------------------------------- Date Final Inspection by: - ------ --- -- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. .9 1-'6B Rev. 5M. r