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FOR OFFICE USE:
<br />APPLICATION FOR SANITATION PERMIT
<br />Mompletp In Triplicate) Permit
<br />....
<br />_ _ 1111...11.11 This Permit Expires I Year From Dot* issued Date Issued
<br />F . �,"�' ""._lit: 2; �.'� v`a`: �� 1J�� t�' .�..• t �fl} � �
<br />w AW7icn*ion is herety made to the Son Joaquin Local Health District for a permit to construct and install the work herein
<br />described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations. jyl
<br />.SOB ADDRESS/LOCAT ONj ENSL15 TRACT
<br />Owner's Name � .................. _...*� ,...........».
<br />. .. Phone
<br />Address _1111 �.. � � 1111.. ............,.........................h. �
<br />City ... 1111..
<br />1111:
<br />Contractor's Name..
<br />.. .........License %. �-'.Phone 1111 _,....,..__....
<br />Installation will serve: Reside ce % Apartment House,E] Commercial EjTrailer Court 0 I
<br />Motel [3 Other...........................................
<br />Number of living units-..-.J ...... Number of bedrooms ...?....,.Garbage Grinder ............ Lot Size ......... ................ .,,<......,.__.._
<br />Water Supply: Public System and name..,...... ...................................,......._.._........,..,._.,..... Itrlvttt
<br />Character of soil to a depth of 3 feet. Sand C] Silt M Clay g PeatIrl Sandy Loam 0 Clay Loam -`
<br />,�, C`S
<br />Hardpan i::] Adobe , Fill Material .... If yes, type .............
<br />(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.)
<br />NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer �is-available within 200 feet,)
<br />PACKAGE TREATMENT (J SEPT C TANK Size.. ..�. .. ._ _ �;�r�� ........ Liquid Depth
<br />Capacity lkt> O...
<br />, TypL'lne..t'�!?,..__. Material 00--e—z. No. Compartments _....,........ �
<br />Distance to nearest: Well ..........:. ... ?................foundation 11 11 ...._.... Prop. Line ..,='..,..._...... r
<br />LEACHING LINE No, of Lines ,�.�Length of each Iine........_ 4"2._t...._ Total Length .... c:9.9..�.....1,111.
<br />'D' Box _ . •{.-- Type Filter Material _,...,, „ ,... Depth filter Material ...... i `1_y *............................
<br />Distance to nearest: Well .,�J'- t 1111...... foundation __. J.,r........._. Property Line .....`✓�,..,...__..
<br />SEEPAGE PIT Depth .._ '5........ Diameter .. _1111- Numbe
<br />Rock Filled Yes (2 No 0
<br />Water Table Depth ................. .t?_................,_.....Rock Size
<br />Distance to nearest. Well .._,...__.... m... l..�.._....._.Foundation ..... P.......... Prep. Line ... ._..._.....
<br />REPAIRIADDITION (Prey. Sanitation Permit # Gate i
<br />SepticTank (Specify Requirements).................. ..-...... ___ ................................ ---_---_- -..... .............. _.., ..................... ,........
<br />_
<br />Disposal Field (Specify Requirements)........................ ........ ..................... ------.-.....__-._..------ .... ............ ....... ......... ,.............
<br />...................... ...__,,.W........ __......... .................. __........................................................ ..,1111..,,,>,....__.._..._._...._ ,
<br />---
<br />..-_-----.-_-.-11.11..-_........... ......................._..............1...._---..,....,.,.�.._
<br />(Draw existing and required addition on reverse side) -
<br />I hereby certify that 1 have prepared this application and that the work will be done in accordance with Sane Joaquin t
<br />County Ordinances, State Laws, and Rules and Regulations of tb# San Joaquin Local Health District. Noma owner or Been-
<br />sed agents signature fortifies the following: I
<br />"I terrify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner
<br />as to become subject t lemon"s Compensation laws of California.,, i
<br />Signed :. �'..... Owner t
<br />�j
<br />By _ >fr1.... _ _11.11...--f-t rz i 4 _ Title ..!{ 1�. i..'1.:....
<br />-- 1111 .....................
<br />(if other than owner)
<br />FOR DEPARTMENT USE ONLY
<br />APPLICATION ACCEPTED BY.,... ...................... DATE r.`'f tw !. 1.1.........11...
<br />BUILDING PERMIT ISSUED ................ ...._... _..DATE ._,...:_.... .,.._._.,__.......,.._........
<br />ADDi'TIONAL COMMENTS____ ................ ......... `......,._..._..__....__.......---_-._...........
<br />.................
<br />............ -_ 1111.
<br />...
<br />Final Inspection by: ............
<br />Hate ,..,.
<br />�.✓����!!.�-y`',,,,,� -111.1. ........................1111. ........... ,�`w .��,.:?,.. �.�''.._.
<br />SAN JOAQUIN LOCAL HEALTH DISTRICT
<br />E. H. 9 1-'68 Rev. 5M a
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