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FOR OFFICE USE: - APPLICATION FOR SANITATION PERMIT ------ 4d---t Permit No. d � (Complete in Triplicate) Lt _ This Permit Expires 1 Year From bate Issued Date lssued�:__;&___o ------------ 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 County.Ordinance No. 549 and existing Rules and Regulations: �/ - ------CENSUS TRACT -------------------------- JOB ADDRESS/LOCATION .-"!__. -�2- - --- ------------ - 'a-i_._ - A Phone ----�- -- Owner's Name Rp� `° - T Cit L -l � `�`� /'4-------------------- Address .� -L ' Y ----------- Contractor's Name -� mmerc' I Trailer Court Phone r License # -.- Installation will serve: Residence ❑ Apartment Buse❑ Co ❑ ❑ Motel ❑Other :. Number of living units:_,____._-_ Number of bedrooms ------------Garbage Grinder ------------ Lot Size --`S - ��------------ -- Water Supply: PublicSystem and name " ------------------------------------------------------------------------------------------ Private Character of soil to a dpth of 3 feet: Sand❑ Sift❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam '❑ Hardpan ❑ Adobe Fill Material ------------ If yes, type ---------------------------- �. (Plot plan, showing size of'lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) �� r ee a e it ermitted if ublic sewer is available within 200 feet,) `r NEW INSTALLATION: € (No � pt+c tank o s p g p p �p / t W PACKAGE TREATMENT [ I SEPTIC TANSize- -�a- - - - � ---------- -------- Liquid Depth ._-- ------- ----- . ' Cap city -�_- �211TypeVV_A"_t Material-- ----- No.F Compartments ----19 V Distance to:nearest: Well -"�Q Q -- ----"---------.Foundation -- - ----------- Prop. Line --- ------------ buACHING LINE No of Lines ----c�-------------- Length of each line__ .---5--------------- Total Length --_ ---_�Q--._--.___. 'DBox _4 ---- Type Filter Material - ' _Depth Filter Material -----Z-- --------------I............ .. ' -,A- Distance to nearest: Well IZ-16 C- ------ Foundation ,1�.4 --------------- Property Line. ------?5 . `' + r SEEPAGE PIT _j Depth ---off--S_r_---- Diameter -3_Vit---�___ Number __._.-P�---------____--- Rock Filled Yes No .�] WatJ Table Depth _---F I-------------------------1,.,-:-Rock ---- -------------1...__-Rock Size - ---------- t Di's'tance to nearest. Well _ -_--_-'------------ ------Foundation 1//0........ Prop. Line . ----- -- ----------- t - a t REPAIR/ADDITION(Prev. Sanitation Permit#.---I-----------------------i------------- --- Date _--_-_----_-_-__-----..._-_-__----1 � I � Septic Tank (Specify Requirements) --------- ----------------- ---------------"-------------------------------------------------•-------••----------------•----------- E 1 011 Disposal Field (Specify Requirements) -------- - -- - - I ----------- ------ -----------•--------------.i { } - -------- -----------------------Y f - -- -- `------ --------- ---------- -------------------------------------------------------------------------------------- (Draw existing and required addition on reverse side) ` I hereby certify that 1 have prepared this application•and that the work will be done in accordance with San Joaquin F County Ordinances, State Laws,?and Rules and Regulatibns of the Son Joaquin Local Health District. Home owner or licen- ' t sed agents signature certifies theollowing: _ "I certify that in the perfor`man a of the work for which this permit isiissued, I shall not employ any person in such manner as to becat a su ject o 11ork n's Compensat,ia laws of California." Signed d -- ---- ------ --- -------------- Owner U16 �. ------ --------------------- Title --------- -------------------------------- ------ ------------------ ., (If other an owner) FOR DEPARTMENT USE LY APPLkCATION ACCEPTED BY 1` ' ' DATE .�_ - - . ---------------------------------- - BUILDING PERMIT ISSUED ------------------ - ------DATE ----------------------- 1. ADDITIONAL COMMENTS ----------- ------------------------- ---------------------------------------------------------------V A------------k--- ` rf _:_____ -- --- ---------------------------------------------------- ----------- e - ----- ------------ Date-Y------ - ---- - -------- ------------ Final Inspection by- ----- ------ - E SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M