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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT a y --------------------------------------------------------- Permit No. (Complete in Triplicate) --------------------------------------------------------- cc ---------------------------------------- ---------------- This-Permit-Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaq(in Local Health Dilict fot=a�perrhit�*to construct and install the work herein described. This application is made in com'lianceff with Cou ty�OrdinariCejN-o.1549 and existing Rules and Regulations: JOB ADDRESS/LOCATION --'-7_g n- ------_t7- -----,--- ltf[---------------I T -`------CENSUS TRACT ----6---t------------ Owner's Name ---------- rJ C - -T - ---------- --------Phone 90----f'._Ho-h�.E-_ . _ . ..� m _ r.Y...� Address --------- -- pt-l�� ------- --- ------- ----------- N- ------------- ` City Contractor's Name ._�7�+1 YCIF T ,------' -------------------- -------:-------- -------License # --------- -------------- Phone ---------------- -------- installation ment Hous/e`❑ Commercial :❑Trailer Court C1 Installation will sere` ResidMotel. ' Other ______ __ f _____________________________ Number of living units------ of bedroo�s __-_________Garbage Grinder --- __--.-- LLoot�Size__.: .__� -_...- Water Supply: Public System and name ----------- `----------------------Private Character of soil to a depth of 3 feet: Sand.' Silt j] Clay ❑ Peat 0�'} Sandy Loam ❑ Clay Loam;0' Hardpan ❑ Adobe ❑ Fill Material .-- If yes,F,type ________________-__f__ a� f A (Plot plan, showing size of lot, location of system in relation to wells, buildings etc. must be placed on reverse'is�ide.) ' NEW INSTALLATION: (No septic tank or seep a pit permitted if public !,ewer is available within 200 feet,); ( � 11 PACKAGE TREATMENT [ ] SEPTICTANK'[ Size-- 5-____- �l I _v--__-•_--._ _--- Liquid De th _.'-LS.-7- ----- Capacity ------ TYp e PRI✓F_A3 3- Material__CDN'4K_ .No. Compartments _ ._Z_.... P Y Distance to nearest: Well _____ __s_b_'-Foundation --- ---------/40--- rap. Lin � LEACHING LINE ['r""'No. of Lines --.-_'_ ____ Length of each Line_-_,___-___-. VP------ Tota, Length '_s_ �: ...... 'D' Box_._�_. _ type Filter Material R�_G ----Depth Filter Material,____-1_-1 ...... ........ / � w. y w { Distance to nearest: Well ._------------ _ __ Foundation T°_ � .____ Pope tyitine.�-��-._-•__ SEEPAGE PIT [ ] Depth _____.Diameter Number ._______________ Rik Fi---- Distance lleda Yep ❑ No 0 Water Table Decpth _____________ ) , t , --------------------------�-------_Rock Size ----t---- -------------- to nearest: Well ---------------------------------------Foundation --- ------ Prop. Line -•-.�---•.-_e:-------- I REPAIR/ADDITION(Prev. Sanitation Permit# --------------------- ------------------ --- Date --------- ------k__-----_--) { I SepticTank (specify Requirements) -------------------------------------------------------------------- --- ---------------------------------------,.------------------ ------- 4 Disposal Field (Specify Requirements) -----------_______ __ -- _ _ -� W i ------------------------------------------------------------------------------ -------------- ------------------ - ----- --- -------- ----- ---------=----t-- -----_ - == ------------ ------------------------- e)---------------------------------------- ------------------------- - (Draw existing and required addition on rev arse sid ` I hereby certify that I have prepared this application and that the work will be donee in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulaons otNeSaJoacl'bin'Local•Health-District. Home owner or licen- sed agents signature certifies the following: r � - j "I certify that in the performance of the work for which this permit is issued, shall not employ any person In suih anner ±�Ji as to become subject to Workman's Compensation laws of California." y03 Signed -- -- --------------------------- Owner 4— ----------- - BY ---------------- ----------------R- L6- - ------ Title ---------------•---- �--- r (if other than owner) 3 FOR-DEPARTMENT�US N Y APPLICATION ACCEPTED-BY------_- [- -` -----------------------------------------------------------:--------- DATE -------�'- --.--- BUILDING--PEI�M—IT ISSUED --------------- --- --DATE _.------------------------_ - > DITIONAL COMMENTS ----------- ------------------------------------------------------------------------------- ' - - - ----------------- - -------------------------------- -----------------------------•-•----------- - ---- - -- -- -- -- --------------------------------•--------------------------------------------------- -' ------- ---- l_In----------------------------- - -------- Final Inspection�by � _> Date -----, -------- --- - - SAN JOAQUIN LOCAL HEALTH DISTRICT h 1 E. H. 9 1-'68 Rev, 5M