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43— FOR OFFICE USE: APPLICATION FOR SANIjATION PERMIT Permit No. 5 �Q_�' ---- (Complete inTriplitatel 3 6 7- --------• Date issued l jo--6y 9._ _4 ` " r This permit Expires 1 Year From bate issued work herein ----------------------- -- - -- --'--- ermit to construct and ulestalnd Regulations- made egulat ons- Application is hereby made to the San Joaquin Local Health District for a P App application is made in compliance with County Ordinance No. 549 and existing No- described. This apP - CENSUS TRACT -------------------------- �' / _ +--- - - Phone --- -- --- - JOB ADDRESS/LOCATION ------F-- --- --Owner's Name Name -- - ---- - - - - - --------•--- City ----------------- ---- --------------- -- ---- ---- --"---- ----•- ---------- --------- '�---- -- - ----"--- - Phone ------------------------------------ , Address - _ .License # ---- --- -- - - - - - ------------- Contractors Name ---- ------------- Residence partment House❑ Commercial ❑Trailer Court installation will serve: ---- ------------------------------ Motel other -------------------------------------------------------- ._"_-- - ----- .. Lot Size - ---- ---- - - ---------- r Garbage Grinder --- -- units:------l----- Number of bedrooms ------- ------------------------------------------------ Private ❑ Number of living ��g _ ----------- ------ (29.1 --------- ------ 1 Public System and name -------------- Sandy Loam 0 Clay'Loam ❑ Silt Water Supply-. � Clay ❑ Peat❑ ---------------------------- Hardpan ------------------------- Character of soil to a depth of 3 feet: Sand [:3 Adobe Fill Material _____- -"--- if Yes,type - \ ` [ — .Hardpan ❑ buildings, etc, must be placed on reverse side.) {Phot plan, showing size of lot, location of system in relation to W ubl'`c sewer is available within 200 feet, I seepage pit permitted if p NEW IN5TALLATION: {No septic tank or - -- - -- ------------- Liquid Depth ------ -------------------- - ------- ---------- i SEPTIC TANK,[ I Size----- ------------------------------- No. Compartments ----------------------- PACKAGE -------------------- PACKAGE TREATMENT [ 1. Material------------------- - No. Compartments -------- Capacity_ ----- Type ----- Pro Line ---------- ------ i.• Foundation -_ Distance to nearest: Well ------------ Total Length Length of each line--------------------- g No. of Lines Depth Filter Material LEACHING LINE [ ) _ - 'D' Box' ------ TYPe Filter Material -------- Property Line ----------------------_---------------"-- Distance to nearest: Well --------------------- ------ Rock Filled Yes [] No i❑ DepthPIT [ l --------------- Diameter - Number ---------------- SEEP � -- -------Roc ---•- Size --- ---- -'-- ---- - ------------------------ Wafter Table Dept ---- ---: -- -------------- ----Foundation -------------------- Prop. Line ---------------------- 'I Well ----------- Distance to nearest: ) I I - Date -- --------------- REPAIR/ADDITION(Prev. Sanitation Permit P (Specify ' mems? -------- - -- -------------- f� �� aX k Disposal Tank Field (Specfy Requirements) -_-- �- ----- -------------------------------- Disposal -- --- �. (Draw existing and re wired ad_______________ -- ------------------- - --- ------ -------- ------------ ----- --_ o�� dition on reverse side) + application and that the wo:k will be done in accordance with San Joaquin 1 hereby certify that 1 have prI pared this apP Re ulations of the San Joaquin Local Health District. Home owner or liters- — i County Ordinances, State Laws, and Rules and J erson in such manner sed agents signature certifies the following: ermit is issued, 1 shall not employ any P "I certify that in the performance of the work for which this p sat-ton laws of Calif as to b ome subject to Workman's Com X__ Owner 4 t Signed - 3itle ---------- BY ------'-- ---- --- - weer} (if other than o FOR .DEPARTMENT uSE ONLY DATE --- ----- ----; d ------------------- ' --------------------------------------- " --DATE -- -- ------------- ---"---- _" 1 APPLICATION ACCEPTED BY -_----- x✓ - ---------- ----------------=----' BUILDING PERMIT ISSUED _ - ��a�. g ADDITION L C M NTS _ - ,ate � �. ------ -------- -- - ----- Date - - -"-------- - - -------------------------- Fina1 Inspection by: --- -- - --� .- - DISTRICT- - -- - ---- -------- -- I. S N JOAQUIN LOCAL HEALTH E. H. 9 1-'68 Rev. 5M