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ter•- � � ' � - �' FOR-OFFICE USE: APPLICATION FOR SANITATION PERMIT permit No. ----------------------- (Complete in Triplicate) --- Date Issue ---------------•--• --- ----------------------------------------------------- This Permit Expires 1 Year From Date issuedd in ----------------------------------- :- --- --- -- re with County Ordinance Na. S49 and existing Rules and Regulations: i lication is hereby made to the San Joaquin Local Health District for a permit to construct and install t e wor e App lication is made in compliance ��,�� 'described. Th ap�b +v�� t' N ?+�" NgUS TRACT -------------------------- JOB ADDRESS/LOCATION ---- --t�_-L�_ ---- -�-1�-.�- ----- --- �`�-`-�-T�--- -�---- �'7��1-3_�---- Phone._ --- �} s.� '�- Owner's Name --------�©-rA -R-�--- ----- N- City ------------------ License # -� - Address - ---��---�-��1�-�-�----- ----- •--R-�-�� ---- ---- -- �.�g".z_b._ Phone .'��---�-- ---------- Contractor's Name G- --E- ----------- - �--- � - - --"- Residence N Apartment HouseC] Commercial'MTrailer Court 0 Installation will serve: , Motel ❑Other -------------------------------------------- ____3 --------- ----- - -- - ----- � - ------- ------- /gip-----�-- ------ --_--Garbage Grinder --N.6--- Lot Size ---- -- Number of living units:----/------- Number of bedrooms __- ---------Private t Water Supply: Public System and name -------------------------- Peat ❑ Sandy Loam .� " Silt-0 Ciay ❑ f Character of soil to a depth of 3 feet: Sand's type Hardpan Adobe 0 Fill Material ------------ if Yes,typ f� system in relation to wells, buildings, etc. must be placed on reverse side.) (\,� (Plot plan, showing size of lot, location of y i it ermitted if public sewer available witthin 2b0 eefi,) �� l NEW INSTALLATION: (No septic tank or seepage p p iqui ep ------------- . __ --- ---------- - --------- PACKAGE TREATMENT [ ] SEPTIC TAN - _---- 1 --- _ _ --- Material-------------- ----- - NoP Compartments �-c•1-�-- Ca acct t'c�` Type t �7 l Capacity Q --- -- ----------Foundation - --- �---�---- Prop. -------- Line ---- -----I-=-------- Distance to neares Well .-_- - � 1 - 2--- Length of each line_----_ Total' Length _ ---•-----•-- ' LEACHING LINE j No. of Lines -------- -- � 'D' Box Type Filter Material -_-`�"----------Depth Fier Materia ----- --- O ---------- Property Line __5_7f ------- Distance -_- "-__---__ Foundation Z©--- Distance to nearest: Well - -f- Rock Filled Yes No Number ------ -- - Diameter f SEEPAGE PIT L�} Depth ----�='�------ , Water Table Depth ----7�------------------------------------ ---- -------------`--'"-" -------Rock Size I - �----------------p. + ---------------Foundation __/6----- ------ Pro Line --•------------------- Distance to nearest: We11 - Date ------- ---- --•------------------) .F REPAIR/ADDITION(Prev. Sanitation Perm -------------------------------------------- ----------- - --------- ----- ------ • -------------------- 4w-. Septic Tank (Specify Requirements) " Disposal Field (Specify Requirements) _------- ------------------------------------------------------------- ----------------l -- - --------- l r -. = ------------------------ }—: - .r --------------------------------------------------------- - - ----------------- �. ---- ------ -- - """-"- - -- {Draw existing and required addition on reverse side) wi ereb certify that I have prepared this application and that the a h Son Joaquin �oawuin Local Ih y Health Q striiill be done in accordct�pHometowner or I ien- i County Ordinances, State Laws, and Rules and Regulations oft e sed agents signature certifies the following: arson in such manner "I certify that in the performance of the work for which this permit is issued, I shall not employ any p as to become subject to Work n's Comp sation qws of California." �,-"-_-- Owner Signed ---- - --- --- -- Title - -------------------------------------------------- BY ----- _ -- ------ ----- ------ ------ ----- --- - ----- ---- ----- - ------ --- �If other than owner)- - FOR DEPARTMENT USE ONLY DATE �f-rf 1a- 7_'?--. APPLICATION ACCEPTED BY --_. t=-------- ----- - - --------- DATE ! BUILDING PERMIT ISSUED ------------------ - -------------- --------------------------------------------- ---------------------------------------------------- ADDl710NAL COMMENTS ------------------------------------ ------------------------------------------------------ -- ----- ------- ---------------------- ----- -------------------------------------------------------------------.�--------- ---- - --•---- ----- - -�` --- --- ---- ---.Dot e --- ----- -------"-- - ---------------------------------------- - ................... - --- ------- Final Inspection y: - -- - -------------------------------- - - f - - ----- "-----SAN JOAQUIN LC?CA!~ HEALTH DISTRICT �. E. H. 9 1-'68 Rev. 5M