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FOR OFFICE USE: APPLICATION FOR SANITATION-PERMIT . "� �7 PerXmit No: --"----- ----- --------- ,� "` - "" {Complete A Triplicate}" ----- ----------- �. Date Issued ---------=-- -----•" ---------=--------- --- ----------------- # This Permit Expires 1 Year From Date Issued } ; ----- - ------------ t t with County Ord;Hance No. 549 and existing Rules and Regulations: Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein , pP ),cation is made in compliance described. This app • .._.�, �-� -.tCENSUS. TRACT -----.- ---- . � -DM •' ( -----Phone ------------------------7--------- JOB ADDRESS/LOCATION ._- - --- -: - Owner's Name _ --- I -1t � � sa .Jr,_.------ City =�- t ------- f m Address ------- -- , rte' +�.r� ' Phone &" f='yam license #I�GZ�� Contractor's Name-tb)--`� �'9 " Residence Apartment House,[] Commercial .[]Trailer Court `0 Installation will serve:..- _ t rl Motel ❑Other ^ -- " Garbage Grinder ------•-'lo#»Size -- -----r------------------- -living --- ----- ---- ----- - --Number of of living units:-- -�--.- Number of bedrooms -------- -- y i "fb 1 ti Private ❑ Water Supply: Public System and name -----; = Clay Peat Sandy L'oarn Ej Clay Loam :[] M1 } - -. Character of soil to a depth of 3 feet: Sand'❑ ❑ Y ❑ e " w, # ( Hardpan ❑ Adobe'ED Fill Material -- -- ------ if yes yp ; stem, in relation 'to wells, build;ngs_etc. must be placed on reverse side.) (Plot plan, showing size of lot, location of sy ,,, _ I ` NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is availa171e within 200feet,) ---------•---------- Liquid Depth ---------------------- SEPTIC TANK [ ] Size_",-:---------------- - - , PACKAGE TREATMENT { 7 p --------- -----• y� Type -- ----------- Material =-- " 'No. Compartments V Capacity -------- ------- Yp - Foundation Prop. Line Distance. to `nearest: Well - Total Length t n LEACHING LINE [ ] No. of Lines --------- ------------- Length of each line-------------------- b' Box - Type Filter Material --------------------Depth Filter Material ---------------------------------------•---- ll Foundation --- -------------------- Property Line Distance to nearest: Well -------------- ;� t"" No 0 Number s- ` --- ---- Rock,;,Filleel Yes ❑ SEEPAGE PIT { } Depth ------- Diameters---- ,;� �=, ----------- - ��— E -- -- =;Rock Size --.- # Water Table -Depth --------------- --. Distance to nearest: Well .------�`-'- ------- -------Foundation ------ ----------- Distance - --- Prop. Line • ----------------- -- Date ----------------------=---------1 � REPAIR/ADDITION{Prev. Sanitation Permit# -------- -------------- --- ------------------ - ----------•----------- Septic Tank (Specify Requirements) --- --r- -- -- ----•-------__- Di s Field (Specify Requirements " --r----------w--------- ------------------------------------ Draw existin an required addition on reverse +► I hereby certify that I have prepared this application and that the San Joaquin Local Health DistrdtnHomece 1towner or I cenh Son - County Ordinances, State Laws, and Rules and Regulations 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 p as to be su 'ect to orkma 's Compensat' laws of California." i �* g �- •��- I -- -- --------- Title ----------------- (If other than owner) FOR DE itTMENT USE ONLY ly ��, �+ DATE ------------------ APPLICATION ACCEPTED BY --------4------- ---------------------------------------------------------- DATE --------- ----- - ----- BUILDING PERMIT ISSUED ------------ ----- ---- - ---------- --------------------------- ---- ----- --------------------------- ------------- ADDITIONAL COMMENTS --------------------- -- / j _ - Date - l--I��f �' ------ -"--- - - - -- ------------------------ Final Inspection by: -- ---- - --'- -- - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.