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FOR OFFICE USE APPLICATION FOR SANITATION PERMIT - a - Permit No: _- ---�-- - -- - �. - (Complete in Triplicate) �t --- 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. Th3,appI ation is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: fj � -- ------------- -CENSUS TRACT ------------------------- JOB ADDRESS/LOCATION ._-��-----------M1�X.�'_�_�4----"------------------ - Owner's Name -------L Q_AISTR-I CTlo--------------a--'- -------Phone---------------------------------- Address ---- __ . City ----LA ROT------------------------------ ------------ Contractor's Name -`------------------ .License # ------------------------ Phone -----------------------••-- Installation will serve: Residence Apartment House°❑ Commercial :❑Trailer Court ',❑ MotelF1 Other -------------------------------------------- Number of living units:---I------ Number of bedrooms "_�------Garbage Grinder YES- Lot Size ________________ r . �,.. _��... -.. Pfiv❑ate Water Suppl,y.-Pu°blic Sy"stem=and•name---- ---GATir' Maf!--= .SI_�T/_ .ICI ATS -7 I ❑ Character of'soil to a depth of 3-feet: -Sand'[] Silt❑ Clay ❑ Peat❑ -Sandy Loam Ciay Loam' Hardpan ❑ Adobe-❑ Fill Material _V --- If yes, type ____________________ ______ E (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed o reverse side.) NEW INSTALLATION: (No septic tank or seeps pit permitted if public�s}wer is available within 200 feet) E V SEPTIC TANK PACKAGE TREATMENT [ ] Size-_, X`C - ------------ Liquid Depth_±�__ —=------- . Capacimaterial � t 1� . `Pro Li' istance to��t:.-Welle�--� V� - Materi�I��a JouIST'_ No�Com art pent e r `� _ Leng#h of each line _ _ q _-- Total Length - �9�-- -------• LEACHING LINE No,y f:Lines __- -------- � i �/ ; f� Box _ Type Filter Material -�Q�_-tDe�th Filter Material ------_/_9_______________________________ Distance to nearest: Well __ 4 _-_____ Foundatio n` -----l0------------- Property Line ____ ______.____.___ SEEPAGE PIT [ ) -Depth ___-- ----___-- Diameter ____"-"-_------ Number9 .___--- "_- ---- Rock Filled Yes ❑ No .I❑ Water Table Depth ------------ ----------=------------ ____--_-_--.Rock Size --"---"------------------------- - Distance to nearest: Well --------------- - ----------------------Foundation ----- --- Prop. Line -__---_-__-------_-- REPAIRfADD1TION(Prev. Sanitation P_eO,6it-# A- "------- -^ 1-Date ------- >----------------�----1 Septic Tank (Specify Requitements) -------- -------------------------------------- ---------------,----------:----- •------------------- ---------- ---------------------------- Disposal Field (Specify Requirements) ----------- -------------------------------------------- ----------------------------- ----------------------------- ----------------- :. _ _ ._ . -- --- ------ ----- ---------------------------------- I Draw existingand required addition on reverse side) I I hereby certify that I have prepped"this cpplifation and"that`,We-wbek—will"be-clone^in�attordance with San Joaquin I County Ordinances, State Law§, and Rules and �Reg u'lcitio s oF, the San Joaquin Local Health District. Home owner or licen- t sed agents signature certifies thie following: "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to become subject to ' =WorkmF f nsat oi n l aws of California." - Ow ner - - -----Signedy BY ------- Title ---- ------------------------------- ------------------------------------ ---------------------- (If ---------------------------------- ----- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _-Li "--- 0L6 E� y t� 2`r�J �' ----. DATE __..�1-1 yz_'j6---.------- ----- BUILDING---RERMIT---ISSUED �'-- ��_ -. ". � P — — `� •,_DATE ADDITIONALCOMMENTS ---------------------------------- ..... '1 --------------------------------------------:------------------- ------------------- I ------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------- -------------------- ----------------------------------------- ------ ------------- -------- Final Inspection b a p Y: ------------------ Date `'' ------- - - --- - --- --------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.