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=FC USE: i APPLICATION FOR SANITATION PERMIT Permit No'. -------- ------ (Complete in Triplicate) --� - Date Issued - - ----------- This Permit Expires1 Year Front Date Issued----- nt Ordinance No. 549 and existing Rules and Regulations. • n is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein Application a in compliance ith [►w y-/ On i A�i fT� 1 fr9 e � ��f described. This a plica" !�V Q CENSUS TRACT -------- --------------- 11-710 JOB ADDRESS/LOCATION f --------------------Phone -------- Owner /� _ - i ------------------------------------------ Owner's Name - ---- . City -� --- �� - Address --- 01 Phone _- i �' IG �ll i= License # Contractor's Name ----- Commercial .Trailer Court I Installation will serve: Residence Apartment House, 171 Mote! ❑Other - _ ---- ------Garbage Grinder �S-- Lot Size --- ---_. ---- Number of living units---,/------- Number of bedrooms __ ----__private i Kara ter of sol tola deSystem th of ga name --------- = Peat❑ Sandy Loam � Clay,Loom Supply: feet: Sand� Silt 1] Clay . -- Cp e ---------------------------- Hardpan --------------------- ---- r Hardpan ❑ Adobe'[], Fill Material 'No yes,type 4 { buildings, etc, must be placed on reverse side• \ ells (Plot plan, showing size of lot, location of system i} relation ittedifw ublic�sewe is available within 200 feet,) �/ Ir NEW INSTALLATION: (No septic tank or seepage p p Liquid Depth -------- --•----- Size- X --------- ----- SEPTIC TANK) f PACKAGE TREATMENT ( 1 t boy off- No. Compartments ---- /�O© Type e FA_J3 Material--------- Capacity --- -- Prop. Line ---�`' ----•----- s�� Foundation -f-- Distance to nearest: Well ----- # - ' cl� Length of each line------- Total Length ---J F� - LEACHING LINE A No• of Lines _---Iq----- /� - 'D' Box /---_ --- TYP e Filter Material !P'�<-------Depth Filter Material ----- I �'O Foundation ---f-�------- ----- - Property ine -.---------- Distance to nearest: Well ------ ----------- Rack Filled yes No 0 I Diameter _-------------- Number -------------- SEEPAGE ,------------ SEEP_ AGS [ ) Depth'- -------------- --- Water Table Depth - -----•--------Rock Size ------------------------------ Water - ---------- ----------•-----•- --------------------------------------- ------------------------------ -- _ -------------------- Distance -- ----- ------- -- Prop. Line --•-----••-----•----•- _-------------- -Foundation - Distance to nearest: Well -------------- ) I ----- Date ------------------------- REPAIR/ADDITION(Prev. Sanitation Permit# -------- ------- I ----------------------- ----------- - ---------- ------- --- Septic Tank (Specify Requirements ---------- --------- - --------------------------------------------------------------- ecif Requirements) ---------_ ------------------------ Disposal Field (Specify ------------------------ ------------------ _. -------- q --------------- -- --------------------------_-- __ - - -----°---=- - {Draw existing and required addition on reverse s� e I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin ' CountyOrdinances, State Laws, and Rules and Regulations of the. San Joaquin local Health District. Horne owner or rcen- sed agents signature certifies the following: ermit is issued, i shall not employ any p erson in such manner "I certify that in the performance of the work for which this p as to become subject to Workman's Compensation laws of California." Owner Signed ! � Title ----- - - -------------- ----- By l/�.1 (If other than owner) FOR DEPARTMENT USE ONLY ` �0 r DATE --- -------- ----- --- _ DATE -.._..--- ----------------------- APPLICATION ACCEPTED BY __-•.-- -- -------------------- BUILDING PERMIT ISSUED `-------------- ----- -- - --------------= ------- ----------- ADDITIONAL COMMENTS t.--------- ------------- - - --- ------ -- - -- ---- --------- ---- ------- - ------ ------- -- ---------------- ------------------------ - to -- --- ------ ---------- --- Date - ---------------- ------------------------ - ----------------------- Final Inspec � t SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M