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FOR OFFICE USE: APPLICATION! FOR SANITATION PERMIT ----------- {Completeiri Trplicatel Permit No: .__ __'_33__.. -----------------------------------------________________ This Permit Expires i Year From Date Issued 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 County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ---- -------VIfI-LLIl�-I'Vj Q /� CENSUS TRACT ---------- 51_ Owner's Name --------------- ------- ---------------------- - -----Phone ------ - ----------------------- ----__ ... S AL11_ C 1------------=-------------- Address ----- ,9o-.�� ------------ City Contractor's Name C' .Y+IIr ----------- --------------------------------License # --------- - ------------ Phone Installation will serve: Residence p ei nt House Commercial ❑Trailer Court ',❑ + l NIMotel E] Other Number of living units------ ---�'�Numb'er_of bedrooms 3----___Garbage Grinder � Lot Size .__/ ��D -' __-_-- Water Supply: Public System and name __________________ _ __ -_ _ ------------ Private! Character of soil to a depth of•3 feet: _ 'Sand'❑ t❑ Clay ❑ Peat El Sandy Loam ❑ Clay Loam� W Hardpan Adobe.0 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.) I o (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) NEW INSTALLATION: °4l PACKAGE TREATMENT ( I SEPTIC TANK�[ ] Size------------------------------------------------ LijuiDepth!................. Capacity-[ Type ------ ---� ": -_ Material No. Crtments - Distance to nearest: Well ------- -----------;``---------------Foundation ---------------- rop. Line -------------:---___-- LEACHING LINE [ No. of Liries _______________________ Le gth of each line______________.____-_------ Totngth _E_______._._ _.._-. D' Box _______ _Tt'pe-.Filter Ma.erial ------------- Depth..-Filter-Material.- ------------- Distance r Distance to nearest.. Well ------- --------------- Foundation -----____--;----- ----- Py Line _.__.____=------------- SEEPAGE _ SEEPAGE PIT Depth ; ,�: - „Rlled YesCT] '. No i❑ �"+ p f Diameter --------- -- Number k Water Table Depth ---------------- - --Rock Size --_------------ P ---- --- --- .. R Distance to nearest: Wei I ----- - ------------------- -----..__Foundation ------------- :- op. Line ----- _ REPAIR ADDITION Prev. Sanitation Permit�# ------------- ry� Date --------------------------- Septic ______________ l i / ------------ Se tic Tank (Specify Requirements)._-_-_ -- --------- i- ---- --------- - r --------- ---------------- ------------- Disposal P P Yl --- ----- bisposal Field (Specify Requirements) ----- 1�, -_ X_______------. ______ ,r / [f _-_-_ /-/ r,___ [Draw existing and required addition on reverse side------- --- � ---�---- ----------- ---------y ----- ----------------------------- ---=- :. 9 q i' ) i. t I hereby certify that I have prepared' this application and that the work will be done in accordance with San iJoaquin Count Ordinances, State Laws aril Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: 1 ; 77 ` - "I certify t t r the a orman of the ork fo hich-this-permit-is-issued,I-sh4ll not emplo any person in such manner as to bec ub' t War Co ns n laws of California." Signed = Owner . , i . ------------- p ----- BY ------------------------------------ -------------------------- �I -i-P----. Title l (If other than owner) F r FOR; DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- '----- i- _ } c - DATE ------- _-- - BUILDING PERMIT ISSUED '--------------- - :,r Fes- - -------�=----------- -----t -----DATE ---------- ADD = ~' ITIONAL-COMMfNTS -_—= - - w - - --- - --�- -__. ___��_� _ - -- - - ------------ ---------------------------------------------- -- ------ - - I- -------- .1 ---- ------- -- --- --- ----- ---------------------------------- -------------------------- - lnspe }_ - Date _ l 1 SAN JOAQUIN LOCAL HEALTH DISTRICT f E. H. 9 1-'68 Rev. 5M d