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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT // Permit No. «_ (Complete in Triplicate) ' ------------- Date Issued -----_-----_-------- --------------- This Permit Expires 1 Year From Date Issued ------- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with unty Ordinance No. 549 arid existing Rules*and Regulations: �i JOB ADDRESS/LOCATIONS - , �}---� .. - CENSUS TRACT -------.: ------------- Owner's Name -- ------`=-SCJ - -------------- -- Phone --,4—I—T7/L Address --------- city '1 ----------•----- --------------- Contractor's Name ...... ___ ---- ---- r -< ' --------- --=�---_.License # ------ ------ Phone _ � ,l:!._P.Q. _ tl .... ---� 'may.,-..>.� -- - Installation will serve: Residence ❑jApartment House❑ Commercial❑Trailer Court 'F] Motel [J O her -4\1 Number of living units:....! ----- Number of bildroom\__13-----Garbage Grinder ---------- Lot Size .__f............. __.--- i s Water Supply: Public System and name ----- -------- ------- \----- ---- -------------------------------- ----------------- -------------------Private I Character of soil to a depth of 3 feet: Sand'❑ silt❑n�Clay Peat E] Sandy Loam El ',Clay`Loam El Hardpan ❑ AdobeX\ill Material -- --------- If yes,type --------- ---.____-_i_ � I - (Phot plan, showing size of lot, location of system in relation to-wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT ----------- Capacity PTIC TANK: -- __-_---- --$izey-_ Mater alt...__��_ No. Compartments ...........:.......... [ J [ ] qDepth TypeII P Distance to nearest. Well ______________ _-9------Found\ation 1--------------------- Prop. Line ____-_-._...___--___- Len Length of each Mine-.-_---__-\_--.._I.._..._ Total Length _.--_------------------- LEACHING LINE [ ] No. of Lines. . . . g t 9 D' Box _._'______ Type.Filter MMaateribl ___________ ______Depth Filfer Material ____..________.._.....__.___-___________-- Distance to�r�earest:y- SII - -�.- _ ......._ Fou Ida ion Property Line SEEPAGE PIT [ j Depth - ----------.- Diameter ---------------- Number ---------------------- Rock Filled Yes ❑ No ❑ Water Table Depth --------------------------------------- ----Rock Size ------------ ----------------- p. -------------p. Lin�e e-_ ..........___..__Distanceto nearest: Well __________________________________ ___._Foundatio ----------\.-Pro lion Prmit# _.______ _.-... ___.- - Date . _REPAIR/ADDITION(Prey. Sanitat ___ Septic Tank (Specify Requiremients) -______-_...._____..._.______. 1--N---------------- .---C------- ------------ rements) vDisposal Field (Specify Req ---------- ----------- ------• -------------------- = — - J _.._ _... ss ` � _' Jr MC�-SSMV f C-its ' ------------------- ------ --- `-i1-'j• --------- ---- ------ -----------------------------------------------------Y--'`Vi --------------- ----- ------- 17 .� (•t�awex0—ing and requi�d additioln on reverse side) n I hereby certify that I have prepared is application and thrat--Sthe work will be done in.-atcordance with San Joaqu)n County Ordinances, State Laws, and Rule}'and-egulations of.-.the, an Joaquin Loccil�th District. Home owner or sed agents signature certifies the following: "I certify that in the performance of the work for which this permit ii:sued,.I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed --- -- --------------------------- -------- Owner I By ' Tit{e - � ------- -------------------•----- ------------ (If other th owner) � i FOR DEPARTMENT USE I ONLY APPLICATION ACC PTED BY.�..._.:�-. - - U_- . ----- ----------------------1----------------------�..I.._. DATE _.S. ` �� BUILDING PERMIT ISSUED _..._...... -- t------- ---------7-f- DATE -- -- ----- - ------------------ ADDITIONALCOMMENTS ----------_-----_---.-•------------------•--•-•--------------------�-------•------------- �-------------------------------- ---- --------------- ------------------------------------------------------------------•----...--._----•-•- -••-------- -------------------------.---.----•--------------------- ----- ----------- --------------------------------------------------------------------------------------------------------------=-----------------------------------------------------------------I ---- - -------------------- ------------ -- ---0 Final Inspection by: -------------- z- r"� Date .... - - -- ---- - --- -- - SAN JOAQUIN LOCAL HEALTH DISTRICT i E E. H. 9 1-'68 Rev. 5M