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FOR OFFICE USE: App�IGATION FOR SANITATION RMI permit No. ------------ - - ------- (Complete in Triplicate) �. Date Issued --- This Permit Expires 1 Year t",com Date Issue ---------- -- ---------- ------ ------------------: permit to construct and install the work herein Application is hereby made to the San Joaquin Local Health District fora No' described. This application is made' in compliance with County Ordinance Noh5a9�Jand existing+Rules and Regulations: ENSUS TRACT ------------------------ P JOB ADDRESS/LOCATION --Pho --- ------------ ----------------------------------- Owner's - `------------------------------- ----------- ---- -------------- ------------- -- --------- Owner s Nam --•- -- --------- City Address __ �� I__L-!_ '' -- c Phone I' . - •-- ----- .License # ��' -� - � -- fi-` Contractor's Name ----- Commercial:❑Trailer Court, ' ? Residence Apartment House'❑ Installation will serve: r Motel ❑Other ----- 7= x _Garbage Grinder -----`- Lot Size -- - ------ Number of living units:._.r-":'- N umber of bedrooms ___---___- private -------------=- ---- -- Water Supply: Public System an fame ------------------------------------ peat❑ Sandy Loam ❑ Cla'y_Loam Ell , Silt❑ Clay ❑ , Character of soil to a depth of 3 feet: Sand'❑ e -- s Hardpan f Adobe '❑ Fill Material _.---------- 1f yes, type # ! etc. must be placed on reverse side.}. (plot plan, showing size of lot, location °5 seepage in permitted if public sewer is available within 200 feet,} � 0V t NEW INSTALLATION: t (No septic tank o p g P J / _____-____. �' ----- Liquid Depth -'.: .. SEPTIC TANK�[ Sizers-�1>�- �-�� --�---- ----- -- ' PACKAGE TREATMENT ] l No. Compartments �4 Type - Material_�� x Capacity -j- -- =------- YP t J; Foundation -- �_� Prop. Line =; V h i i ,�, 4 Distance'to nearest: Well ---------- , - Total Length -l° No. of Lines - --�--------------- Length of each line____!- ---- �� .. ^ LEACHING LINE [,� V1 'D' Box.:-_ --- --- Type Filter Material ....a � - --Depth Filter Material ---- - --- ------ '--`-- � Line -.5---- ---�------:..-- �A DistanceFt nearest: Well "___i_P_ ----------- Foundation --- ------------ Property Rock Filled Yes Z No SEEPAGE PIT [�I Depth ;-- 5- Diameter _q --- ---- Number .........�---- ----- --.� �Water Table Depth --------------------------------------------- I _ -------------------------- Rock Size i �. ---------------- Foundation -------------------- Prop. Line -------- ---- ------- ✓ Distanc6!to nearest: Well --- ----------------------------------- ---------------------------- ' k I REPAIR/ADDITION(Prev)Sanitation Permit --------- ----------- Date ------------- } y s Septic Tank (Specify Requirements} ----------------- ------ --------__--- uirements] -------------- ------------------------------------------ ecif Req ---------------------------------- Disposal Field (Specify ---- -------------------------- I ------------- ------ -------------------------------- -------------------------------- ,... -. '; A I ---------------------------w-----t^ --:-------- - - ------------------------- ------ ;-------- _ � I (Draw existing and required addition on reverse side) f the San-Joaquin Local Health District. Home owner or liven- C 1 hereby;certify that I have prepared this application annsthoat the work will'be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations { — _ - � � sed agents signature certifies-thmit,is issued,e following: I shall not employ any parson in such manner "1 certify that in the performance of the work for which this per _. . as to become subiect to Workman's Compensation laws of California'."' j Owner SignedJ - --------------- ------------------ ------- ---- Title -- - - i4 By (If other th&n owner) aa- (' { FOR. .DEPARTMENT USE ONLY - t`' DATE : . . ..... .. :_ DATE i APPLICATION ACCEPTED BY'-R--_- - - - ---� u ------------ -- - BUILDING PERMIT ISSUED --------------------------------------------------- -- ---- ----- ----- ---- ------ ------- __.----------------------- - �------------------------------------ ------ ------------------------------- ADDITIONAL COMMENTS ----------------------------- -------------- ------------------- --------------------------------------------- --------------- * - ----- ------------------- ti Date ,7 ----- - - - - - Final Inspection by: --- - s SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M•