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FPR OFFICE USE: APPLICATION FOR SANITATION PERMIT �1 7z ip, Permit No. -_-_-- a.. [Complete in Triplicate} J - Date Issued " --." -------- This Permit Expires 1 Year From Date slue with County Ordinance No. 49 and existing Rules and Regulations: Application is hereby made to the San Joaquin Loc al,Health District for a permit to construct and install the work herein pp application is made in compliance described. This app i ---CENSUS TRACT �- _ f JOB ADDRESS/LOC 10 f Phone `--------------------------- Owner's Name ------ cis �� - Address -------- ---4 {- --- --- -$- -------- License # - -- --J�.-�y- Phone ----------------------------- -------- J ""--`' = Contractor's Name -_ r Court '0 Con Commercial:OTraile Installation will serve: Residence [Apartment House 0 Motel ❑Other -------------------------------- ------ ,,. Lot Size ----- ---------- --- -- - Garbage Grinder __-_-__--__ Number of living un -----------------------------------------------------Number of bedrooms ____ -- --- - ---_Private Water Supply: Public System and name -------------� - -- ---- peat❑ Sandy.Loam -C], ._Clay Loam,[]_., Character of soil to a depth of 3 feet: Sand'[ Silt❑ Clay :[*. .:' Adobe Fill Material ------------ If Yes,type ,.. v_ p U laced on reverse side.} Ian showing._s_ize,of lot, location of system in relation to wells, buildings, etc. must be p (Plotp, . 4 permitted if public sewer is available within 200 feet,) } NEW INSTALLATION: (No septic tai k or seepage pit p --------------- ------- Liquid Depth -------------------- O r SEPTIC TANK:[ ] Size------------------------------------------------ TREATMENT [ 7 s F -- ---- -- ' - Type _--::---------� "--- Material--------------- --- No. Compartments Capacity_------- - - I -----Foundation ---------------------- Prop. Line ----- -=-- Distance 'to nearest: Well --- ----� Total Length -, ------------------------------ -------------- Length Length of each line------------------- - LEACHING LINE [ } No. of Lines =.------- D' Box ------- ---- Type Filter Material --------------------Depth Filter Materia _ Property Line - Distance to nearest: Well ____ -__.------ ------ Foundation ------------- ---_ Rock Filled Yes C] ' No (` ' j SEEPAGE PIT Number --------------------- [ } Depth --------- Diameter - Water Table Depth�We11 ._ ---- -- ---------- ------------Rock Size -------------------------------- Pro Line -------------- ------ � ------------Foundation -------------------- p. Distance to nearest: ----------`--- • ; . d I� -------------------- Date ----- ----------------------------j ------------------------- REPAIR/ADDITION fPrev. Sanitation- ermi --- �. Septic lank (Specify Requirements} -----N----- ------------ --- Y--- --- ' ----- -- ------- ------------� � � - - - --- ----- ---- ---------------- _ --- --------- posal Field (Specify Requirements) 12- l _ -------- l-�9 - - ------------------- 0 ----- �--------. rf(Drc;�t_exi_sti_n`g__a_nd requ;red addition on rev rse side) e hereby certify that 1 have prepared this application and that the aworkkwil be done in District.accordance h Sang Joaquin li I Y cen- County Ordinances, State Laws, and Rules and Regulations of theJoaquin sed agents signature certifies the Following: permit is issued, 1 shall not employ any person. in such manner "I certify that in the performance of the work for which this as to become subject to Workman's Compensation laws of California." e - ----- -- --Ow ------nerSigned - ----------------------------------------- -- - --- - -d-441 itle - --- - - --- --------------------------------------- 11f other than owner) . FOR .DEPARTMENT USE ONLY S-`1 � ---•---------------- -- APPLICATION ACCEPTED BY '` ----------------------------------------- -------� DATE _-� ---- ---------- DATE - --------------------------- BUILDING PERMIT ISSUED ----C.- -- ------------------------------------------------------------------------- ------- -- ---------------------------------------- ADDITIONAL COMMENTS ------------------------- ¢ --------------------- _ -------------------------------------------------- ---- ----- ---- ----- ---- ---------- ---- - -- -------------- ---------- -Date _ -S�_'_ - Final Inspection b ---- --------------- ---------- - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.