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FOR OFFICE USE, -APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Triplicate) Date Issued ��c1/�-1 This Permit Expires 1 Year From Date issued in -- ----:---- - t with County Ordinance No. 549 and existing Rules and Regulations: Application is hereby made to the San :Joaquin Local,Health District for a permit to construct and install the work ere Bance described. This application is made in compliance CENSUS TRACT ---------------•----•----- JOB ADDRESS/LOCATION .-� = ------ -------------------Phone ----------------------- Owner's Name !_11 ------ --- ----- city - v* i -------------- Contractor's Phone . ,. 'Address ----- -- J�---" - --- � f _ License #� j --------------- l Contractor's Name ------- p� " � Trailer Court Installation will serve: Residence X Apartment House❑ Commercial ❑ Motel ❑ Other -------------------------------- ----- dl _ --- � Lot Size �- - - - -___-_--Garbage Grinder _ - t Number of living units:-_/----- Number of bedrooms -private, Water Supply: Public System and name --------------- -- Peat❑ Sandy Loam ❑ Clay Loam r Silt❑ CIuY ❑ Character of soil to a depth of 3 feet: Sand'❑ e --------------------------- - L Hardpan E] Adobe E] Fill Material __----__---- if Yes,type [ etc. must be placed on reverse side.) k (Plot plan, showing size of lot, location of system in relation to wells, b ewergs, etc.able within 20b feet,) G\ I it permitted if public r. - NEW INSTALLATION; (No septi tank or seepage p p / '� Liquid Depth --•------------- 0 Size -------- PACKAGE TREATMENT [ ] SEPTIC TANK �,.�..-._.._..._.. �� Y : � e . No. Compartments W Capacity ` Prop. Line _ k - Foundation f d Distance.. to nearest: 19 Well --. -�� Total Length �eZ9........ LEACHING LINE kjtJ No. of Lines --- -------------- Length of�ach line-- s Depth=FilterTMatenal-` -=--=-- ----=------------t-----'-�-� T e Filter Materia - ---.- - V Boxy' Yf?_ u. .-�. — - Property Line - ------•-•----- - '�-__ _ Foundation 1:91-0- -------------- - --------- Distance to nearest: Well _- / " No �❑ ,. � Rock Filled Yes 4 t. Depth �_ --- -- Diamete Number SEEPAGE PIT [ l P / -----Rock Size i-- -------- , p �j i ` ll�Vyj�, Water Table Depth �. ------ -- Prop. Line _ _ _--_-- Foundation -Distance - to nearest: Well ,-� � - -.. ) REPAIR/ADDITION[Prev. Sanitation Permit# -------- ----------------------------------- ------------ I Date --------------------- Septic Tank (Specify Requirements) -------- ------------------------ --------------- ---------------- --------------------------- } t F..n -- -------------------"_-__-- --_--__-_--_- j Dis osal Field (specifyRequirements] - - ------------------ ----------- - --------------------------- _.: t [Draw existing and required add'++tion on reverse side) in certify that I have prepared this ace with So pplication and that the a Joaquin Local Health D str11 ict nHo O owner or l cen- 1 be done in acc I hereby y County Ordinances, State Laws, and Rules and Regulations of the 9 person in such manner sed agents signature certifies filie following: I shall not employ any p "I certify that in the performance of the work for which this permit is issued, as to become subject to Workman's Compensation laws of California." 0 Owner ----------------------------- ------- Signe -- ------------------------------ --- __ -------- Title - Y Cher than owner) FOR DEPARTMEN U O LY //� �/ - ----- ---------- -------=---- - ----- -- --- - - - DATE �P - APPLICATION ACCEPTED BY _-------------- _-DATE --� -- -- --------------- ---- ---- ----- ---- ----------- --- ---- -- -------- BUILDING PERMIT ISSUED ---- ------- ------- ----- -------------------------------------------------------------------------------------- ADDITIONAL COMMENTS I---- ------------------------------------------------------------- ----------------------------------------------,-------------------- ----------------- - J - - -- ----- -- - .--- - ----------------- --------------- ---- -� �� - ---- ----- - - ---- -- ate --- ---- ----- ---- ----- ---- -------------------------------- ----------------------------------- - ------- -------------------------- - - Final Inspection by: --.-- -------------- SAN JOAQUIN LOCAL HEALTH DI CT 1 1_'AA Rav- 5M