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i OFFICE USE. APPLICATION FOR SANITATION PERMIT Permit No. -.(--0- _ 37f --------- ------ --------- F , (Complete in Triplicate) .� Date Issued This Permit Expires 1 Year From date issued --------------------. hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein Application is he y This a Vicmad is made in compliance with County Ordinance No. 54�and existing Rules and Regulations- described. ego ations: described. pp ENSUS TRACT JOB ADDRESS/LOCATION �.�- �/j/-- �/- -_--_--_- Phone sj / , . ' I'C'J-" _h --------- -- -04Owner's Name City fT`k P�D.- ..- ... _u - Jr " �� Q,� Phone s P---1 111- R. License #�� Contractor's Na a - ----- V 1 y Commercial ❑Trailer Court ❑ Residence � Apartment House'[3 installation Will serve: --- h 61t K Motel Q Other ------------------------------------------ --- ---- ---- ---------- -------•---- ----- Number of living units:---__�---- Number of bedrooms "_ ----.Garbage Grinder _--P--- Lot Size ----- _•_____________Private ------------------------------------------------- Water ---------------------------=------------------ i Water Supply: Public System and name -_------ -- ----- .Peat❑ Sandy Loam .0 Clay Loams] Character of soil to a depth of 3 feet: Sand'Q S-,-, ilt Clay ❑ Adobe'Q Fill Material if yes, type ------------------------ H a rd p a n —�—�—� [ laced on reverse side.) b\ (plot plan, showing size of lot, location of system in relation�°f publi availablecsewergs, within 200 feet,) NEW INSTALLATION: (No septi tank or seepage pit p Liquid Depth _ ----- SEPTIC TANK'[ I Size------------------------------------ -- PACKAGE TREATMENT [ ] No. Compartments _---------------- = Capacity --------- ----- ---- Type -------------------- Material I Distance to nearest: Well ------------------------------------Foundation -------------------- -- ---- -- --Foundation ---- ---- ----------- Prop. Line ----------------°=-•-- - No. of Lines ---------------- - - ---- Length of each line------ --------------------- Total Length ---------------------------- LEACV 11NG LINE L S Depth Filter Materia -------------------- ----------------------- 'D' Box:=--- ----- - Type Filter Material -------------------- ------------ Property tine_ ---- ----------•--•--•-- E __---_ Foundation ---_------_ ° Distancelto nearest: Weil --------------- -- Rock Filled Yes ❑ No I � ---- Number �-------- ---- - --- - Depth _ Diameter -_----- --- ------------------- � SEEPAGE PIT t ) i - ----------------- ---•-Rock Size --------- ---------------------- Water Table Depth ---------------------- --•- J � --------------- -- -Foundation ----- ------=-•---- Prop. tine ----------------- � Distance to nearest: Well ---------- ------- ----- ----------- Date - - - - ) k ----- REPAIRfAdDITION(Prev. Sanitation Permit -••------- ----- - Septic Tank (Specify Requirements) -------------------------------- ' ---•------ -------- tic C � 0 TO---- 0�`-- ------- "If fa ( Disposal Field (Specify eq - •--------- - --- ---- -- ---- - y ( ------------------- (Draw existing and required addition on reverse side) l % lication and that the work will be done in accordance with San Joaquin I hereby certify that 1 have prepared ared this app Re Regulations of the San Joaquin Local Health District. Horne owner or licen- I County Ordinances, State Laws, and Rules and 9 j to vny pe "I certify that in the performance orson,in such manner sed agents signature certifies the following: i f the work for which this permit is issued, I shall not emp y as to become subject to Workman's Compensation laws of California." E { Owner Signed --------------------------------------------------------------------------------------------------------- ----- ------------------------------------ - ------------------------------------------------ 'Title ------------------ ---------------------------- 'Title (if other than ner) FOR .DEPARTMENT USE ONLY i DATE = -1_.,'Z ---- ------- - - -- ----- ------ -- --- ----- ----------- ----- ----- ----------- - -DATE --------------------------- --------------- I APPLICATION ACCEPTED BY -------------- ------------------------ -----------------------------------------------------------------=------------------------- BUILDING PERMIT ISSUED ---�------ ----------- -- --- ------ ------------- •-------- t ------------------------------------ ADDITIONAL COMMENTS ------------------ -------- i --------------------------------- -- ----------------------- --------------- --- ---------------------------- --------------- - ------------------- i -- --- ----------- ----- ------------ -----------Date -� -- ---- ---- --- - - Finai Inspection by: ----------------- - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.