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FOR OFFICE USE: APPLICATION- FOR SANITATION PERMIT permit No _� -P c1 ------------- ------- (Complete in Triplicate) 6 �� ----------------------------- Date Issue - -- ----- -------- -- ��. - -, , 4 This Permit Expires 1 Year Frain Date Issue - - ----- - with County.Ordinance a 549 and existing Rules and Regulations: Application is hereby made to the San Joaquin Local District for a permit to construct and instal! the work herein Applic described.�This application is made in compliance CENSUS TRACT ----------- ----------- ------ �- ---------- JOB ADDRESS/LOCATION p ]:i Phone �7 --------------------------- --------- Owner's Name --- - Cit --------------------------------- ------- -- ---- ---- ---------- -----------•--- Address --- -------- --- Phone ----------------------------- s .. -- .License # ---- ----. -- ------- - - ----- - -- -- - - ----------------------------------------------- - ---- Contractor's NameCommercial oTrailer Court ❑ Installation will serve: Residence ❑Apartment House's y Motel ❑Other -------------------------------------------- ------•-•--- ## ------Garbage Grinder's----- Lot Size oz�-------------- Number ----- --- Number of living units------ Number of bedrooms -_---Private V? i _ - Water Supply: Public System and name --------------------- Clay peat❑ Sand Loam ❑ Clay,!oam ❑ ' Silt❑ � ❑ Y ; Character of soil to a depth of 3 feet: Sand'❑ - F - - - --- If Yes,type -- ----- ---- -- -- -- - 1 Hardpan ❑ Adobe ill Material a flocationsystem in relation to wells, buildings ctc4 mst;be Placed on reverse side.] (Plot plan, showing size of lot, of y a .: rt ermitted if public sewer is avaElable within 200 feet,) �n } NEW INSTALLATION: INo septi tank or seepage p' p Size------------------------- ------------------- Liquid Depth - PACKAGE TREATMENT 4 1 SEPTIC TANK'[ } ----------- No. Compartments S ( ------------------ yType -------------------- Material---- Capacit ----------- -:- ----- -- ----- ----•---------Foundation - ------- ---- ------ Prop. Line ---�----•----------:- Distance!to nearest: Well ---- 2 - Total Length -----------•----------- r' s No. of Lines ----------- ------- Length of each line--------------------- - . LEACHING LINE [ I ,�,. � -----------Depth Filter Material -------------------------------------- ------ , V 7 e Filter Material ----------- !1 p' Box i' YP Property Line .._ ' _ --_--- Foundation ------------------------D•+stance`to nearest: Well --------------- _ Rock Filled YesxQ No Diameter Number ------------ F SEEPAGE PVT [ l Depth '-------- �I p ---------:-------------------- -Prop. Line--; Rock Size Water Table Det " ---- ---------Foundation - ---------- ------ Distance to nearest: Well ------------------------ 1r Date -------------- ) i REPAIR/ADDITION(Prev. Sanitation Permit --------------------l I p k1 - -- _f .,- - -- -- -- - -- - � Septic Tank (Specify Requirements) ----- - -- ---- -------------- -- - ---- - ----------- 1 Disposal Field (Specify Requirements) (- �� --- ----- ----L ------------=------------------------------------- I -- -----°--:- ---- ----- ---- ---- I ----------- # (Draw existing and required addition on reverse side) -------------------------------------------- --- --= ----------- --- -------------=-..-------- -- --- ------- -- f.; - .T - ------------------ - ----------------------- -- the San Joaquin Local Health District. Horne,owner or licen hereby certify that I have pr�pared.-this application and thf t the work will be done in accordance with San.Joaquin., G l he y County Ordinances, State Laws, and 'Rules and Regulations o arson in such manner sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, l shall not employ any p . as to become sublet to Workman_s Coritpensation laws of California." ,- ----� Owner - - -- ----- -- -------- - ------------ Signed ----- ------ - ----- ------ Title - ------------------ -- -- f other than owner) FOR DEPARTMENT USE ONLY Y _--------- ---------- DATE APPLICATION ACCEPTED BY �j ` � 1 ._Z': ,r DATE BUILDING PERMIT ISSUED - € - T_ - ----------:----- ---- -- ----- ADDITIONAL COMMENTS - ---- ------ ------=---'- .. .. ------------ ------------ ---------------------- Date 7� T'= � ------------------------- ---------------------------- Final Inspection by: ----- t� SAN JOAQUIN LOCAL HEALTH DISTRICT � � g E. H. 9 1-'68 Rev. 5M