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FOR_O_F.ICE USE: APPLICATION FOR SANITATION PERMIT �n �PeTmi-A?" ----------- ,. -------------------------------------- - (Complete in Triplicate} dna .-�� p Date Issue = --------- ;r This Permit Ex ires S-Year From Date Issued ----------------------------------------- --------------- ,. I Application is hereby made to the complin Loance ocwial Nh Couealth�ytord orrict dinance Nom5"49 and ex st'ng Rules tand hRegulations. described. This application is } p _ N i ___ ___ ._: .__2 ._•. 0 � . "- `/ s '---- -'-- 4CENSUS TRACT _- JOB ADDRESS1LOCATI ----------/- ----- �� Phone _.rfQ�� Owner's me -- -------- ----------- ---------- City 4S c' L = Addres hone - -- - Contractor's Name _ _;___.__- ---- �� - Installation will serve: Residence]Apartment House Commercial ,]Trailer Court l0 .g a.., Motel ❑Other -----------------i------------- A - : ---------- ------- Garbage Grinder _Ll+'=V--- lot Size -- -. Number of living units:_-Number of bedrooms _ _.____ ., Priva e ` I Water Supply: Public System and name ------------ ------------- y Clay Loam -� Silt. Clay ❑ Peat[3 -,Sandy Loam - Character of soil to a depth of,3 feet: Sand's ❑ Hard"pan "s Aclobe Q, l ill Material AU_ , Lfayes, type.:--------------------------- - { k ' buildings, etc. must Molaced on reverse side.) Q0 (Plot plan, showing size of lot. location,of:�system'm�relation�to wells, •� A ` �ert'is available witliin`200 feet,) NEW INSTALLATION: (No septic or seepage,p�t pelmitted if public sews i i\{ ` i s— Liquid_Depth -------------------------- J' PACKAGE TREATMENT [ ] SEPTIC TANK [ ] � Size----------- ---------•-- -- ------------ Compartments - I . ---- No. Compartmen s ; ' �J ) Capacity ---- ------ Type Material Prop. Line • _ es#: Wel! Distance to near , Foundation ________--- - s. '" ¥ h --.------ LEACHING LINE [ ] No. of Lines __-- ---------`j4__ Length of each line-------------------- I t - 'D' Box _ -`---- - -- TYpe Filter Material --------------------Depth Filter Materiai -------------------• ---------------------- -- - ` T 4, _-_ _ ��: Property Line. --------- -------------- Distance to nearest: Well ----------------------•- Foundation ---------------- SEEPAGE PIT [ � Depth I Diameter --__------ --- Number -------------------------- Rock Filled Yes .Q No s -----------kRock Size -------------- - Wafter Table Depth ------------- - 1 Foundation -------------------- Prop. Line ------------- Distance to nearest: Well _______-------------•---------- ------- s REPAIR/ (Prev. Sanitation Permit# ---- r ------------------- ) I '--- - _ ---- ------ -Septic Tank (Specify Requiremets) -------------- r t --. Disposal Field (Specify-Requirements) ___ t�_ s ------- '� -------^--- .js ,-.... - --------- - P - ---- '------- --- --- ------ -----i J. ---- --- ------ ---------- ---------------_ ' - -----------[ -. " ;(Draw existing and required additi non reverse side) JoaquinSun certify that I have prepared this application and that the work will be done in accordance 'to owner or 1 cen- ( 1 hereby ce fy County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. k sed agents signature certifies the following: erson in such manner "l certify that in the performance,of the work for which this permit is issued, I shall not employ any p k as to become subject to Workman's Compensation laws of California." a __ Owner Signed __ ---- ---------------------- -------------------------- - ,.._ --- i _ --- -- 0--- Title ` B40 (If other than owner) I t FOR DEPARTMENT USE ONLY ___11 - APPLICATION ACCEPTED SY . f- 4 -- --- ��: �.� ._ �� -. - - - ---r ----DATE t " - =' BUILDING PERM IT-15SUED'�_s_._'�'-_- -- -- - -- --- -- ------- --------------------- ADDITIONAL ---'-- -- ----- ADDITIONAL COMMENTS _ - ---------------------------1=---------•--- f ------- ------ _ , __ -- __-- --------- - _ _ _I_- - - __ - -67- -- -- to Final Inspection` ------- SAN - -- - _� _l _ ---- --- -- ---- SAN JOAQUIN LOCAL HEALTH DISTRICT 4 E. H. 9 1-'68 Rev. 5M