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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT - Permit No. --- . -- {Complete in Triplicate) .�/S J� ---- ---- ---- ------------- This-------- --------- : ` ; .l Date issued ----------- ---- y This Permit Expires 1 Year From Dale issued ----------- -------- --------------------------- -- - --- 4 nce 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 workherein pP :in compliance described. This application is made .,.--..f CENSUS TRACT ' �9 <t� ,(�1---------------1 ----- - JOB ADDRESS/LOCATION .-- O-—------F------ -------Phone.-lam+✓- P_."_-- i . �� s Owner's Name --W.19-U-e(/V----- % _5� / City - - Jro� I 3 Phone: _i License # - � �. ----- Contractor's Name "f-/F` ----- - �_ Residence [4-Apartment House'❑ Commercial [ Trailer Court ',❑ installation will serve: : - Motel ❑Other ---------------------------------- ----------- ------------------ Lot Size ---- ----- --------------------------------- I Number of living units:----- - Number_of bedrooms " =-Garbage Grinder -------- Private [ ---- Public System and name --------------------------------,�.;—.------------------------------------------------------- WaterClay Loam ZI Characterofsoil to a depth of 3 fee.. Silt❑ Peat❑ Sandy Loam ❑ Supply: Clay ❑ tSand❑ , Hardpan ❑ Adobe Zq�Fill Material ------ I yes, p ti nt laced on reverse side.) (Plot plan, showing size of�lot, location of system I in relation wells, buildings, etc. must e p �' �t ermined if publicise er is available within 200 feet,J INSTALLATION: (No septic tank or seepage P p I 1 1 -) Size------------------------ ---------------- PACKAGE - ---- •---- -- - Liquid Depth - ------------------ NEW -.-•--- 0. ' PACKAGE TREATMENT C I SEPTIC TANK''L 1Y'"" --- ---------------•- . . Material.:`- Na. Compartments Capacity±� fTyp � ----4-'__ ., Type --------------------T- ---------- -•--•-Foundation ------------------ --- Prop. Line ------------•-----•--- � . Distance to neat- WeI�P� Total Length ----------------------------- --I --------- Length of each lineg LEACHING LINE [ ] No. of Lines "--- -- r - Depth Filter Material �.l 'D' Box ; --------- Type Filter Material ------------ -- Property Line. __------ t -_ Foundation -------------------- to nearest: Well -------------------- Rack Filled Yes ❑ No �❑ Distance)" Number ------------ i t _ Diameter ----------------- ' SEEPAGE PIT L ] Depth ------------ I Water Table Depth I ------- ----------------- Rock Size --------------- Foundation Prop. ine "_.----•- 4 Distance to nearest: Well --------------------------- � I ---- ----- Date -- - ----- -l-=� ----- --"1 REPAIR/ADDITION(Prev. Sanitation Permit -------- -----------------------------.,--------------------- i Septic Tank (Specify Requirements) ------- ---- G ------------------------ ------ Disposal Field {Specify Requirements) ---�/ -`-'--sem - -------------------------- I F . _ f`fir -- -- --- ---- --- ------- -- ------------- C ----- -- (Draw existingand required addition on reverse side) ` certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin I hereby Y Ordinances, State Laws,'and Rules and Regulations of the San Joaquin Local Health District. Home owner or icen- Count y ermit is issued, I shall not employ any person in such manner � sed agents signature certifies the following: k "I certify that in the performance of the work for which this p as to become subject to Workman's Compensation laws of California." t. Owner Signe ----- ----- - ----------------------------- I ---------------- Title - 1-------------- ------ i By ----- ------------(lf other than owrier) FOR DEPARTMENT USE ONLY .0111 1,111 111 DATE - e� 69-------------- Y V APPLICATION ACCEPTED B -- ------------ DATE _." ------------=-------•--• --------------- BUILDING PERMIT ISSUED ------� ----- ----------- ----------- ADDITIONAL COMMENTS --.-_I- ---------------------- ----------------------------------------- ----- ` F ----- ----------------------------------------------------------------------------- --- --- ------------ - - -------------------------------- - 1� ------- .Date ----- ---- ------------------------------------------------- - ---- - - ------------------------------------------------ ------------------------------ Yh" - `----- -- -- - ----------- - Fina! Inspection by: -------- - - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'b8 Rev. 5M 3