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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ---��-��-U- (Complete in Triplicate) Date issued --- -.9--7 P i ----------------- -------------------- ------------- This Permit Expires 1 Year From ate issued l Application is hereby made to the San Joaquin Local Health District f�a permit to construct and install the work e-. ` pP s described. This application is made in compliance with County Ord�nan�e No. 549 and existing Rules and Regulations-. x.6.5 ------CENSUS TRACT -------- ; JOB ADDRESS/LOCATION £ ` ------------------------------------------Phone Owner's Name -------------- - -- ------- ------------------------------ Y + Address -------------------------- - ----------- License # ----- ---.-------------- Phone i Contractor's Name ------------ sResidence ❑ Apartment House'❑ Com T ercial ❑Troller Court l Installation will serve: � l Motel ❑Other -•----------------------------------------- � s � Lot Size - ------------------------------ u ------- Number of living units:.._. _._. Nu`m of bedrooms .3-------Garbage rinder -----Private f ----------------------------------- ------�----------------------- WaterSSupply: Public System an name Sandy Loam 0Clay-Loam Ch�6ra titer of soil to a depth of 3 feet: sand❑ Silr❑ Clay E] Peat❑ If yes,type ---------------------------- Hardpan ❑ Adobe ElFill Mate1 ia.l _-._--- - Profit Ian, showing size of lot, location of system in relation to well, buildings, etc. must be placed on reverse side.} { p ,t ermined if public sewer is available within 200 feet,) I NEW,INSTALLATION: (No septic to k.or seeps P p Liquid Depth _-- 4----- size ` - SEP TANK'f 'ra�CoQ� PACKAGE TREATMENT [ 3 I. ,. �Q-�___ No. Compartments ! � ------ Material --------- p i Capacity1 1 ---------- Type r 3` -- t ------- ---Foundation --/-2- ------ Prop. Line _ ---�- _Distance to Barest: Well __-- - t (j J gv Tota! Lenity�'--�g-• ---------- LEA( LINE [�No. of Lines ----- - -------------- Length of each n�li��nee-_60X!` .wFr Depth Filter Material ------ -----------------------•-----•----------•- `_ -- Type Filter Ma#erial� - 'D' Box Yp -� Line. Ar' --.._ ------•-- � T Foundation _--_�-�------------- Property - ' Distance to nearest: Well __ --- f No ❑ W ; Qf 3 Rock Filled Yes �/ Depth"'" jZ".'"'—"`Diameterµ.t_Kl--=---- Num er SEEPA�L"f- --- ---- ----- -- Water Table Depth ------------------------------------- Rock Size -------------------------------- Water ------ ----- ----------- - r - 70or i \.OFoundation -------- Distance :- Prop. Line _....D.... Distance to nearest: Well ---1fw " } ¢ Date --1•------------•------- ------- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- ---•--- ----- Septic Tank (Specify Requirements} ------------------------------------------------------------ Disposal Field !Specify Requirements) ------------------ ---------------- i --------------------- -------------------- --------------- ------------ -----------t--------- ------------------------------------ --------------------------------------------- - ---- ------------------------------------Ire - - e -- `n accords, (Draw existing and required addition on reverse side) accordance with San Joa4uin 1 hereby certify that I have prepared this application and that the work will be done es, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner County Ordinance+licen- 111 sed agents signature certifies the following: permit is issued, I shall ria- employ any person in such manner "I certify that in the performance of the work for which this p as to becom i t to Workm s Comp s tion laws of California." (I$ Owner Signed - ---- _ ------ ------ Title ----- ---- -- --- ------ ------" ------ ------ -------------------- By ----- ------------- - ------- -- ---------- (If other than owner} FOR DEPARTMENT USE ONLY DATE ---6'--Ar--Z --------------- ----=---- APPLICATION ACCEPTED BY ---- -- -------------------- ! DATE -------------- ----------------------•---- 1 ------------------------------------ -� , :__�.�4-... :=°-`------ ----------------- ----------------------------------------- BUILDING PERMIT ISSUED -------------------------------------------------------------------------------------------=------------ i. ADDITIONAL COMMENTS -------------- ---- - --------------------------------------------------------- - ----------- - ---- k .........................................•__....__•-_....-..._.__.._._._-•_••____•• ---------------------------------- ----------- .------------ -._.. •- ••...................•_•_•__•-__••__..._------.___•_-•___-••_-- _ ---------------------------- - - ----------- -- ---------------- -------------------------------------------------------------------- inspection b -------- ---- SAN JOAQUIN ..LOCAL HEALTH DISTRICT t E. H. 9 1-'68 Rev. 5M, h