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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 2 Permit No. -------------- --------------------- ------------ (Complete in Triplicate) ----- -------- > Date Issued __ �� --•- - ----------- This Permit Expires 1 Year From Date Issued _ Application is her made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is made'in compliance with County Ordinance.No. 549 and existing Rules and Regulations: , .CENSUS TRACT -------------- --•-------- - JOB ADDRESS/LOCATIO __---�� C---4^Cp�itFl -------- Owner's Name Phone ------------------------------------ ,J� -- u- --. city/_0 � ---------------- ------ Address _�- -- kilo �� ------- "� Y ------------------- - / �`a ! " ' License # '`� 1 Phone } Contractor's Name __.__ �-......L Installation will serve: Residence [KApartment House❑ Commerciat ❑Trailer Court !❑ ) r Motel ❑ Other -------------------------------------------- Number of living units:_------- Number of bedrooms __457---Garbage Grinder ------------ Lot Size ---------------------------------------- Private ❑ Water Supply: Public System and name -------------------------------------------------------------------------------------------------------- Character of sail to a depth of 3 feet: Si Silt C] Clay F-1Peat C1 Sandy Loam -E] Clay Loom ❑ Hardpan ❑ Adobe'❑, Fill Material ____- _____: If yes, type-r- -=--------------- i (Plot plan, showing size of loft, location of systeml m relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet) Q s PACKAGE TREATMENT [ ] SEPTIC TANK[ ] Size-------------------- -------------------------- Liquid Depth -------------------------- % -- No. Compartments --------_-------- Capacity ____________ Ca acit ------- k Type Materia{ p P Y "' --- /le t. . _ ---- -F undation --------------------- Prop. Line = Distance to nearest' -- Total Length -------------------•• � ea8h th Falter MatenaiLEACHING LINE [ ] No. of Lines i � ---- of reach lin - ---- gr --- -- PD' Box ------ Type fFlier I --------------- DeP:$ .�',,_ � Y s .-..r : --r .- •w- ww. - Distance to nearest: Well ____ _________ Foun ation .__. roperty Line ______._____-------_---Rock FilledYes ❑ No i❑SEEPAGE PIT De th ------ Diamete ---------- N ber -------------------------- Water Table Depth Rock Size! _ Pro Line --- ------------------ Distance to nearest: We11 # ll,____-- Foundation ------------------- P I � � I_ Date ----------------------------------) REPAIR/ADDITION(Prev. Sanitation Permit# -----I a--- --------------- - ] 1ws _ _ Septic Tank (Specify Requirements) -------------4 -------- -----------------------�------------------------------------------------ st -- ------ --------------------- -- Disposal Field (Specify Requirements) -------------- � t r _ _ s > ------.. . -- tl --------------------- Draw existi,g and required addition on reverse side) licatiort and that the work will be done in accordanc a with San Joaquin I hereby certify that I have prepared this appli i) Regulations o f the San Joaquin Local Health District. Home owner or licen County Ordinances, State Laws, and Rules an - sed agents signature certifies the following: ' "I 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 Wo an's Compensati. n laws of California." Signed --- --- ---------------------- Owner --------- --- ---- --- ------- --------- _ P Title -------- ------ ----------------------- ------------------------------- BY ----- ---- .- r ------ (I other than owner), FOR DEPARTMENT USE ONLY � --- ACCEPTED BY _.___ _ --- ---------- -- ----- -- ------------------------------ DATE ----- Fes------------------------------ APPLICATION ---- --------DAT - ---------------------------------------- BUILDING PERMIT ISSUED --------- ------------------------------------------------- ADDITIONAL COMMENTS ----------- ---- ------------- ---------- ------------- --------- ------------------------------------------------------------------------------------------- ------------------------------ ----------------------------------------------------------------- ---- ---------------Date ----------- - �l.----------------------- Final Inspection by. -- ---- SAN .JOAQUIN LOCAL HEALTH DISTRICT F H 9 1-'68 Rev. 5M -� �--