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40 APPLICATION FOR SANITATION PERMIT permit No: -- - � FOR OFFICE USE': late in Tripli+tate) V "� -� 1ComP Date Issued ' --------- his Permit Expires 1 Year From Date Issue i -------" ermit to construct and install the work herein - -------------- -- ------------------ Rules and Regulations: �' made to the San Joaquin Local Health District or a p Bance with County Ordinance No. 549 and existing Application is hereby in comp ' � 6-410 CENSUS TRACT ---------------- '""_" lication is mg desc�nbed. This app / "��--- -- --- - -�C��/�'''9�-- - -�--"- --- -- -- ---- - . --- - --- --- - --- - ---- --Phone _.��----- JOB ADDRESS/LOCATION - ---------- ---------- ------7--- - f _- City f -_-_-__-_--- Owner's Name -.--- --- . 4�3• ---------------- -- -- ,�Q�ZJ.-- Phone k Address -------- Court License # _ ' .� '� � - Trailer Court `❑ - Contractor's Name "-�� Commercial ❑ installation will serve: Fse ResidenceXApartment Nouse'❑ Other ---------- --------------------------------- ---------- -- Motel ❑ _ G9--�` Lot Size -- - E, Garbage Grinder k Private ® Number of bedrooms •�- ---" units:._.!------- - --- -- ------------------------------•---- � Number of living _____ --------------" Cloy Loam 0 Peat❑ Sandy Loam '0 Water Supply: Public System and name --- --- "-- Siit❑ Clay ❑ a Sand depth of 3 feet: Fill Material ------------ if Yes, type Character of soil to a dap Hardpan ❑ Adobe buildings, etc. must be placed on reverse side-1 Size of lot, location of system in relation to wells, seweris available within 200 feet,l (Plot plan, showing it permitted if public NEW INSTALLATION: lNo septic tank or seepageP p ------- Liquid Depth ------------ Size------------------------------ ----------------•=---- ' SEPTIC TANK'[ ] _- No. Compartments PACKAGETREATMENT I } Material-------- - --- --- - ` ---------- Capacity Type --------------- Line ----------7-= ...�� Y ------------ - --- -- -- -- - -- ------Foundation �-- --- ------------- Prof• i� r S -------------- Distance to nearest: Well ----------------------------- --------- - - _ _ Total Length fJ------------ [ No. of Lines - --- / Length of each ,��- - .. LEACHING LINE L 1 f --- ------ } Depth Filter Material ----/ Type Filter Material/ Line __�- No rsr�i D. Box ` F'- Foundation Property Distance to newest: Well _"-.�� Rock Filled Yes C l Number --------,------- Depth - Diameter f 1 -------- SEEPAGE PIT [ ] -------_-•-_--Rock Size _ + a---------- Line ----•- Water Table Depth ----- Foundation --- � Prop. l ----------- Distance to nearest: Well -------- Date --- "1 REPAIR/ADDITION(Prev. Sanitation Fermi - ------------ - (Specify Requirements) ' 1 A! Sepfiic Tank (Sp Y �------- ecif Requirements) �� ------ Disposal Field (Sp Yr, --- , jacquin -------------------------- __-______.___..----- - {Draw existing and required addition on reverse si e this application and that the work will Local Health District.ne in Hometowner or I een- k hereby certify that I have prepared County Ordinances, State Laws, and Rules and Regulations of the San Joaquinan erson in such manner sed agents signature certifies the following: ch t "1 certify that in the performance of the work for whi ton (laws off Cal'fornia,+�ssued, I shall not employ y P 4 as to become ' ct to oxk an s Comp Signed ---- ---- - __ �_ Owner —.- --------- ' - ---------- Title -------------------------------------------- - By 11f other than owner) , ARTMENT USE ONLY DATE ---=-7 -- ! - ---------------------------------- -- ---- --------- DATE ------------------- APPLICATION ACCEPTED BY - l, ----------------------------- BUILDING PERMIT ISSUED ---___----- -- ----- --- -- -------- ----- - ------------------------------------------------------------------------- -/.- .- -------- ------------------ --- ADDITIONAL COMMENTS E f '� -[/ � ------ --- -- -------- - -- •------------- ` %" --- ' ----- --- - ----------------- -- ---------- ---------- -------------- �� ---- --- - -- ------- ----- ---------Date --- ---- -•--�� - . r Final Inspection by: -- ---- -- -- - --- -- -- - - - S f N AQU1N LOCAL HEALTH DISTRICT E H. 9 1-'68 Rev. 5M