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FOR OFFICE USE:I APPLICATION FOR SANITATION PERMIT Permit No: --- ---------------- � (Complete in Triplicate) Date kssued -_- -- ��-L ---- ----------------- This Permit Expires 1 Year From Date Issued --------------------- �. } aunt Ordinance No. 549 and existing Rules and Regulations- Appl�ca tion is hereby made to� fihe San Joaquin Local Health Di trict for a permit to construct and install the work-herein ere�n described. This application is�'mode in compliance w CENSUS TRACT ----------- - ---- ---- ---- - JOB ADDRESS/LOCATION .--'-_Phone -------------------- -i __ ----------------------- 00 Owner's} Name ---- �, I City - 1 /�!/ -------- Address -. ✓- -- f l --------------------------- ` !' phone - -�-07; lee License #aF- Contracto�s Name11 Ile '- �' I Commercial ❑Trailer Court House In ,❑ Residence Apartment ❑ stallation will serve: „ 1 S Lot Size --�„-� .E. Motel F] Other -------------------------------------------- �'--- ----------•----•- Garbage Grinder -4----- Number of units:---- � -- Number of bedrooms - --- -------------------------------------------------------------Private ---- Water Supply: Public System,an name _----------- ❑ Sand Loam .❑ Clay Loam ❑ • �' I Silt Clay ❑ Peat Y Character of'soil to a depth of 3 feet: Sand'❑ ❑ l '! Hardpan ❑ Adobe Fill Material ------------ if Yes,type l ► laced on reverse side.) buildings, etc, must be p i (Plot plan, showing size of.lot, location of system in relation to wekks, ; ''F'%* ! it permitted if public sewer i available within 200 feet,) !, se tic tank or seepage p p . - � f W :�.�I ` --------- Liquid Depth - PACKAGE TREATMENT [ ] SEPTIC TANK',-- --� __„�, .re' i -•-_- NEW INSTALLATION: l o l - No. Compartments -- --- --------- Co'; r '' - T e -�" --e��T�,Matenai Capacity, = Yp / Foundaion�- :"I _ _ Prop. Line -� ---------------- F Distance i to nearest.. Well ------ - Length of each line_-- -- ---- Total; Length _�`-"�------------•-----•. �)' No. of Lines ---- ---- ------ 1 1 �'+. . LEACHING LINE. t e Filter Material, -4 -Depth filter Material , ------ ' ' " " 'D) Box )_ Ty Line. -•---------- J � � Property r ` Foundation -- f Distance.to nearest: Well -_- - �� f ' Rock Filled Yes ,(F No �❑ d , --- Number -------�----- t 4 _ . _ Diameter - SEEPAGE PIT ' Dv pth --�' -- r --.__.Rock Size _.�--"".--�`------------- -------------- ater Table Depth ---------- Prop. Line .-� .- .--"__.__._.Foundation - D-+stance to nearest: Well -----/� ) i - - Date -----�------------------ REPAIR/ADDITION(Prev. Sanitation Permit# ---- ._ 1 ��,R. . : ----------- - -------------------- Septic Tank (Specify Requirements) --------- - ---- -------------- - -r_------------- ---------------------- - '' �" Disposal Field (SpecifyI Requirements) -------- -----------;------------------�--------- - -------- ----- ---� - --- --- -- -------------------------------- = (Draw existing and required addition on reverse side) prepared this application and that the work will be done in accordance with San Joaquin l hereby certify that I 'have prep County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owr r or licen- ty sed agents signature certifies the following: pe is issued, I shall not employ any person in such manner "I certify that in the performance of the work for which this p as to become subiect to Workman's Compensation laws of California." • Owner 1 1/ ----------------- Si ned ----------- g --- (1f of r # I;an owner I, FOR DEPARTMENT USE ONLY DATE":._L_1------------ -'----- -- ARPLICATIO ACCEPTED BY -- ------ -- DATE ------------ --------- --- BUILDING PERMIT ISSUED ---- ----------------- ------------ ------------------------------------•-- r ADDITIONAL COMMENTS ---- --------------------- ------------------------------------------ --------------- - - ------------------- r ------------ - ------------------------ ------------ ---------- ----- Date ------------------ Final inspection by: a� SAN JOAQAQ UI LOCAL HEALTH DISTRICT G a 1-'68 Rev. 5M