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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. -� =- 7/ ------------------- ------------------------- (Complete in Triplicate) ------------------ Date issued _-L---- ---_� ------------------ This Permit Expires 1 Year From ate issued ------------- I+cation is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein App ' described. This application is made'in compliance with County Ordinance No. 549 and existing Rules and Regulations. CENSUS TRACT ---------------------- JOB ADDRESS/LOCATION --------- ------ ------------------- --------- /v� /� --- -- -= --------------------Phone -------------------------------•---- Owner's Name ---------------1 Joao. /'A f'�f �7I'7L� _.- City _ QD.LrST0------------ ----------- ------•-------------•------ Address - ------ --------------- - ----------------- ------------ - ------License # ----- ------------------ Pone ------------------------------ Contractor's ---------------- - -- - - -- Contractor's Name -------------------- ----------------- -------------------------- -- Residence "Apartment House-E] Commercial []Trailer Court i❑ Installation will serve: �y F Motel Ll Other --___!�a�« Lot Size -----------©� -------------- Number of living units ___-- NuImber of bedrooms ___2_____Garbage Grinder - ------ private ❑ ----------------•-•---------------- �^-� ------ Wafter Supply: Public System and name ------------ -- ------------------•------------_--Pe ❑ y. C a Loam ❑ { Silt Glory ❑ Sdnd Loam ^- ❑ Y O --r-Character- depth of 3 feet: Sand ❑ ❑""'� Hardpan E] AdobeFill Material ______._.__ if yes,type __ on (Plot plan, showing size of lot, location of system in relation to wells, buildings available within 200 feet,) reverse side.) ` NEW INSTALLATION: (No_septic�tank or seepage pit permitted if public sewer is a --------------- Size PACKAGE TREATNIEIVT�[gL SEP IICTANK'D Size-------f w(dCL--- - - ------------ ----- - q P r �- Type I _C � __ Mciterial_<42 ----- No. Compartments 'Capacity - , "r ,f Distance to nearest. 'Well ___ -�-----------1-------Foundation ----- Prop. Line ____ ---•--=--- No. ofLi es - _------ ---- Length of each line------ �-- ------ Total Length -----$$0-------------- • LEACHING LINE [ .. �.� ! 'D' Boz o- eS..__ Type.Filter`Material ----Depth Filter Material -._-. ---- "' a �Q 171 --- Foundation ------/ --1'1iN-_ Property Line ------ ------- ion + Distance to nearest: Well,.--�, ,� ---_--_ Rock Filled Yes ❑ No Depth Diameter' Number ------------ SEEPAGE PIT [ } p ---------------- { - - - - Foundation -------- ----------- p.Rock Size -------------------------------- Water Table Depth ------------------------------- -- � Pro Line ----------------••--�- Distance to nearest: Well --------------------- ------------•------ 1 ----- ---- Date ---------------------------------- ) • --------------------- REPAIR/ADDITION(Prev. Sanitation Perm+t I [ ---------- ----------------------------------------- -- - Septic Tank (Specify Requirements ---------- ----- - --------------------------- t i Disposal Field (Specify Requirements ---------------•------- -------------------------------------------------------------------- ----- ------- _ _ (Draw existing and required addition on reverse side) Joaquin I hereby certify that I have prepared this application I lication and that the work will be done in accordance with San ' County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: person in such mannet ' "1 certify that in the performance of the work for which this permit is issued, I shall not employ any as to be ome subject to Workman's Compensation laws of California." �—•��r �x•- -_,:. Owner ti* Signed �� 4 ---- ----- Title -------------------------------------------------------------------- By - --- ------ ----- -- _ - ---------------------------------------------- --------------- ------ --- (If other than owner) " FOR DEPARTMENT SE ONLY -_ DATE - APPLICATION ACCEPTED BY .---.--- ------------------------ --- - BUILDINGPERMIT ISSUED ----- I----------------------------------- ------- --------------------------------------------------- ADDITIONAL COMMENTS - ---- ----------- --------- ---•---------- ----------------------- -------------------- ------ - ------------- ---------- ------------------------------------------------------------------ - ------------------------------------------ ------- ---- ------------- --------------------- T. ----- at ;z'y- ------------ ------ - - -- ----- -------Date ----- -- ------------------------ Inspection b ------------------------- FinalSAN JOAQUIN LOCAL HEALTH TRICT c- r H 9 1-'68 Rev. 5M