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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -1 j 9 5 b Permit No,. --- ------------- --------------------- - - ---------- ---------- (Complete in Triplicate) ---------=--------- ------------------- Date Issued This Permit Expires 1 Year From Date Issue Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: ------------------------ - -.0 SUS TRACT JOB ADDRESS/LOCA O a _Phone ---------------- -------•--------- Owner's Name ? ------•------••- j Address .... City - `� � -r---.License # � 'Phone3 �/� 1� Contractor's Name _ 1101— �• ------ mercial . Trailer Court Installation will serve: Residence Apartment House❑ Com ❑ Motel ❑Other -------------------------------------------- Lot Size -----t-Asx-of--------------------- Number --------------- ------------------- Number of living units:______f___ Number of bedrooms -------Garbage Grinder ---a------ Lot Size ""_-� �Privat ------------------------------- Private ❑ - - -- ---------- - --- Water Supply: Public System and name ----------------------•---------- -� ❑ Peat Sand Loam Clay Loam .[D Character of soil to a depth of 3 feet: Sandy Silt-0 Ciay ❑ ❑ Y Hardpan ❑ Adobe ❑ Fill Material ------------ If yes,type --------- ------------------ must be placed on reverse side.) [Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. NEW INSTALLATION: (No septic tank or seepage pit permittedAf public sewer is available within 200 feet,) SEPTIC TANK:( ] Size------------------------------------- ------ Liquid Depth -------------•-------.----- PACKAGE TREATMENT [ ] No. Compartments {� Capacity I------------- -- Type Material------------------ p Distance to nearest: Well ------------------------------------Foundation ---- - - --------- ----------------Foundation -------------- Prop. Line-----------------• LEACHING LINE [ ] No. of Lines - _______"___ Length of each line____------------------ - Total Length ---- E f 'D' Box _�______ -- T-yp-e Filter Material ____________________Depth Filter Materia "_--- ----- - ----- j Property Line -----------•---- t ----- Foundation ------------------------ Distance Depth _-- Diameter ---------------• Number --------------- -------- --- Rock Filled Yes ❑ No ❑ SEEPAGE PIT [ ] p ---'------------ - � � Rock Size ------------------------------ WaterTable Depth ------------------------------------------------ 'tFoundation -------------------- Prop. Line -_..----------------- i Distance to nearest: Well -------------------------------- REPAIR/ADDITION(Prev. Sanitation Permit# -------•----------------- ------ Date ----------------------------------] Septic Tank (Specify Requirements) ------------ -=.- ------- - -------------•------- ---,.------s------- ---- ----- - ---- -- ----- pe I Disp I Field (Specify equirements) _"-man G« � - � ---- --------------------- ------------------ -------- -------------------------- -- ---- -- - -- ' {Draw existing and required lad� on on reverse side) r k will be done in accordance with San Joaquin I hereby certify that I have prepared this application and that the war County Ordinances, Slate Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- F sed agents signature certifies the following: I "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Owner Signed - ie --- - - �] G° ii ------------------------------------------ Title -" -- VZ --s- ----------------- ------- ------------- -------- (if other an Aver) FOR DEPARTMENT USE ONLY APPLICATION..ACCEP,TED. BY - - - --- ------------------------------------------------ DATE 7l - --------- ----- BUILDING PERMIT ISSUED -------- - --------------------------------------------------------- BUILDING COMMENTS ------'�-�-=-E---------------------------------------------- - -------------- ------- --- .ri► ----------------- ------------------- ----------------------- ------------------ ---------- { --------------------- ---------- ------------ ---------------------------------- - ---- ------------------------------------------------------- ------------------------------------ -------- --------- - -- -- -- ------------------------- ------- t DateJ�J 7 _ Final Inspection by: --------- ------ - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'b8 Rev. 5M