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��- PERMIT f Permit No-. - FICE USE: ' APPLICATION FOR SANITATION _ --- - (Comp lete in Triplicate) 3 Date issued --- ----------- ---------------- This Permit expires 1 Year From Date issued herein -- - Regulations' - --------- - ----- -_"--� €---- -- ----------------- ---- � permit to construct and install the work l - Rules and Reg uin Local Health District for o p 549 and existing E Ordinance No. S-4-6 ------------ licatior► is hereby made to the San Joaq Bance wifih County CENSUS TRACT - APP . (-cation is made in comp descrrbed. ,T his app .. -y� t--�--�--�-- - ---- -- Phone --- - -- -- -- JOB ADDRESS/LOCATION .--- 27 -------- -- - Owne'r's Name ----- ------- City _ Phone -cense # - i Address - ---- u T Commercial ❑ Trailer Cdurt ;❑ Contr,actor's Name -- - - - ,._. .�--- —` " � APO"' -------- --------------- Installation House❑ ❑ AP Residence --- -- Installlation will serve: ------------------- I i Motel ❑Other ti ; . . Lot Size -- ---- Garbage Grinder -- ,.__.._�- Private units:_.--��_. -- Number of bedrooms--3- .. - �_��4 ------------ --- -•. Number of living „. - ------------------------------------------- ---- --- -- -- ---- --- ---- Laam ' Clay Loam .❑ ._, Sandy ' l Public System and name ------ -- -- ---- - -------- Clay ❑ Peat❑ SuPP Y= Silt❑ if yes, type Character of soil to a depth of 3 feet: sand'[1 fill Material __------ --- ef Hardpan ❑ Adobe ❑ � y .etc. must be placed on reverse side.) j public sewer is availal;le within 200 feet,( showing size of lot, location of system in relatiottnedto`f wells, buildings, lan, sh ,-- F i (Plot p Liquid Depth No septic.tank or seepage pit perm NSW INSTALLATION: l SfcPTIC TANK;) 7 Size----------------------- ----- compartments -. PA -------------------- No. CKAGE TREATMENT 17 ----- Material---------------------- Prop. Line ------------------- • - -- Type ----- ---- - - ' Capacity --=------- --- ----Foundation ------- ------- i ---------------- pistance�to nearest: Well -------- ----- -- - _s Total Length :--- ------- y' Length of each line--------------- ' Depth Filter Material ------------- -------------- --------- LEACHING�LINE [ ] No. of Lines --- ---. Dep Type Filter Material --------- Property Line ------------ p' Box ; Foundation - No ` - Rock Filled Yes ❑ l —Distance-to nearest: Weil --------- --- --- -- - - F Diameter ---------------- Number ------- -------- -- i Depth SEEPS PIT [�l ... -Rock Size ----------------------- Water ---------- --- --- ----------- SEEPAGE ----- Water Table Depth _--- --- prop. Line ----------------•----- ----------Foundation -------------------- Distance to nearest: Well ) - -- - Date ----------------------- -------------------------------------------- REPAIR/ADDITION(Prev. Sanitation Permit# ----- ---- ----------------" fi Requirements) ----------------- ------------------------ septic ----------- Septic Tank (Specify ,t - Disposal IField (Specify Requirements(,.----- ------------- ----------- ` ! �°` -- -- ------------------------ --------------- -------------------------- {- 3 r ---- - ------------------- ----- -----_- -------------------------- ` and required addition on reverse side) � (Draw existing this appluin ication and that the work will LocalHealthD sirctnHome tOwner or Ih Son cen I hereby certify that I have prepared County Ordt.inances, Slate Laws, and Rules and Regulations of the San oag arson in such manna sed agents signature certifies the following: permit is issued, I shall not employ any p i "I certify that in the performance of the work for,which this as a become subject to Workman's Compensation laws of Caiiforniaa." Jam_.Owner --------------- -------------- Signed'------'---------------------------------- ---- --- - �� -- -- _r�Title ._. - -- ---- '' -------------- 4 . BY ------------------(if other than owner) FOR DEPARTMENT USE ONLY �r- ----------------- --------- -- ---- ---- -- DATE _ ._'I ' -------------------- DATE ------- -------------------------------- APPLICATION ACCEPTED BY _ -- - ----------- ------------- --------------- ------. BUILDING PERMIT. ISSUED -------- ------ / ---------- - ---------------------------- ----------------COMMENTS -------------- ----- --- - -- -------- ---------------- - - ► ------------ --------------------------------------- -------------------- --------------- --------------------------------------------- N ______________ _-__.-. ----- r _- ---"------------------------ �._____- - - .-"- _ ----- ----------------- ---- -- -- -- ----- - ----------------------- ate _-�- -- -----� ---- - - -- - ------------------------------- --- ------------------ Final Inspection y: - SAN JOAQUIN LOCAL HEALTH DISTRICT ,n E. H. 9 1-'68 Rev. 5M. :..