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FOR OFFICE: ¢ `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 per to construct and install the work herein described. This application is made in compliance with County Ordinance No. 5%499 and existing Rules and Regulations- JOB ADDRESS/LOCATION ._-- _ _7 _ .._ A.—AR�� (r_-C�-:-A------iP.4Z / __CENSUS TRACT l -------- ------Phone �-fig 02-'lam Owner's Name .--- -- ��------�'��--�/_,.�1?F----- -��l/_L L-_� ------------ -�- - ,3_ -7 wiz G0-1 -- cit S7 �Lcwn ---------------------------------------- Address -- ----------- /VJ-------- - Y Contractor's Name __----SAM ------------------------ -----.License # --------: ------ -- Phone ---- ----------------------- Installation will serve: Residence[]Apartment House Commercial :❑Trailer Court I❑ Motel ❑Other -------------------------------------------- t of living units:--_.-_._____ Number of bedrooms ---Z----Garbage Grinder --___- Lot Size _________________ _--- ---__Private ❑ Water Supply: Public System and name ___-__-_________________________ ___ _ - 11 Character of soil to a depth of 3 feet: Sand'❑ Silt ❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam Hardpan ❑ Adobe-F7 Fill Material ----_.- ---- IfYes, type ---------------------------- l ,,. (Plot 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,) I ---- PACKAGE TREATMENT ] Capacity I NK' Size----------------------- -------------------- Liquid Depth 1 �!__... _ Cap y 011 Type - l' _�Sf Material--- Gam° Nor. . Comfa FTnts „ � ► Distance to nearest: Well - �lr...�Y`urn S----f�Fo dation.-=M_�}t' ' ' Prop. Line _jV,1jji'I_!!'Mu!'"-- trF7� � Length of each line-------9 a-- _ - Total Length ---/A!° -------------- LEACHING LINE [ ] No. of Lines _______________.---____-- Len g 1 D' Box -----�_ -- Type Filter Materiel --------------------Depth filter Materia,l --F_______---------•----- V It / / ,--Pro line � Distance to nearest: Well -___ }_---''---=- Foundation _.___.__._ _ ; , party SEEPAGE PIT [ ] Depth Diameter --------------- Number -----------------------------'Rock 1. Filled Yes ❑ No ..0 I Water Table Depth ------------------------------------------------Rock Size ------------------------=------- ] I t i Distance to :lnearest. Well --------------------------1' __:___I.. -ion - Prop. ro Line _____..._ _ R9PAIRJA4DITION(Prev. Sanitatioin Permit# ----_---. -----=---------------------- Date -------------------------------=-- Septi– ank (Specify Requirements) ----------- ------------------------------------------------ !55' ----------------------- = --------------------- ---- ----------- -------------------- -------------- ---•--peciYa uienes#s) ` ' 47 - 107 ----------=- ----------------------------- ------------- ---- Il a i/a 6/e- u_4-le-----------v '.C- ------------- --- - I (Draw existing and required addition on reverse si I hereby certify that I have prepared this application and that the work will be dome in accordance,with San Joaquin County Ordinances, State Laws, and Rules and Regulations of-the San Joaquin WWI Health District. H me owner or licen- sed agents signature certifies the following: ` - "I certify that in the performance of the work for which ghis permit is issued, I shell not-etnptey any person in stach manner as to become ubject to Workma m ation laws of Californi Signe - ---=-= =--------- er ..C / jyLLQ. Own ------- :-- ------- ------------------- -----------------j--------- --------#--- ------------------------------- -------- (If - ---(If other than owner) FOR DEPARTbAlliNT USE ONLY T l APPLICATION ACCEPTED BY DATE - n - -BUIL-DING PERMIT ISSUED --------= == = _ ------------ -- ---------------------DATE _ __ ---- ADDITIONALCOMMENTS ---- ----------------------------------------------------------------- -----,----- ------- ---- ' i.: - -------------------------------------------- ------------- - f . ... __________________________________________________________________________ _ ____ Final Inspection by: --- -- --------- --- ----� ��- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M