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FOR OFFICE USE: App IC TION \FOR SANITATION PERMIT Permit No. ----- (Complete, Triplicate) -- --- -- --- - -- ------ -- Date Issued ._l.C�'--------- -------------- i .4 --""--"--. This Permit Expires 1 Year From Date issued ------------------------------ --- ------------------------------- ; Ordinance Nd. 549 and existing Rules and Regulations: made to the San Joaquin Local Health bistr;ct for a permit to construct and install the work herein Application is hereby m a compliance with Coun y ---------- described. This appiicat;on is made in comp i3®� %y��•-- CEN5U5 TRACT ----d --- i 1`- •-------- TIOIv/ac i�',6� --- �[ -:----- --- --- --Phone------------------•--- JOB ADDRESS/LO -- _-° r- Owner's Name --- . v� Phone �7 City ---- - Sr _.£-- --- ' --- - - --------------- k Address .--.- " __ _ ---- --------.License # �� : i Contractor's Name -_ -_ "- -_. Commercial ❑Trailer Court Residence ❑ Apartment House❑ � installation will serve: Motel ❑ Other ------------ Lot Size ---------------------- - i - "� Garbage Grinder--------- -- ! Number of liven un+ts:"._"�------ Number d bedrooms ------------ Private ------------- F Water Supply: Public System and ,hamar-------- ;;_ Sandy Loam • Clay Loam ❑ L � Silt fl`� Clay ❑ Peat ❑ Character of soil to a'depth.of 3'feet: Sand ❑ �Fl11 Material ---------- If Yes, type " i 'N I Hardpan ❑ Adobe'❑ - ; j. etc. must be placed on reverse side.) o (plot plan, showing size -of 1ot;.location of system ;n relation to w lbsewerg+s available within 200-feet,) " p e i# permitted if public i No septic tank or see g p Pa i NEW INSTALLATION: [ _"� �m ---- Liquid-Dep#h Size7�/„2 :/ i SEPTIC TANK'[ ` No. Compartments - - PACKAGE TREATMENT [ 1 IMaterial _-" " -"-- - i acct_[;1_P0Type i Cap !-y -- " istance to neare :Well - >------------- Foundation 1 Prop. Line - �y �'� Total Length~ f-------- ---- ! ' Length of each line ---- -- ---- f No. of-lines ----�"---- -'----� ----- -- { LEACHING LINE, [ �, "Depth Filter Material------- p' Box,--- Type Filter Material _. I � � ---- ---- Property Line - -- 4 Distance# o nearest: Weil ---_ Z6---------- Foundation ---- Rock Filled Yes �No .i❑ 3 ��_ Number '? ----- Diameter -----------!.. {{ Depth �� i SEEP_ A� PIT [ ! �� "rY"3 ------ j bo-_j`=r Rock Size r Wa#er4Tab1, Depth ------------- - V t }} 'Q - Prop. Line .__. nce to nearest: Well 1 - Foundation - } Date---------------------------- REPAIR/ADDITION (Prev. Sanitation Permit ------------------------ ----- i Septic Tank {Specif Req _ � .k { Requirements) -------------•- ---------- -------- ----------- --------------- DisposaV Field )Specify Req '- --------------------------------- ---- ---- ------ r ------------------------- -- ------------------ ---------------------------- --------------------------------- ---------=---------------------- - -- --- - --- -. ---------- ------------ --" {Draw existing and required addition on reverse s+ e ; 1 have prepared this application and that the woroawuin Localill be oHealth D's riictrdanHomce etowne'r or 1 cenn ne in OccO I hereby certify that P � E county Ordinances, State Laws, and Rules and Regulations of the San g arson in such manner sed agents signature certifies the Following: I shall not employ any P 4 � "-I certify that in the performance of the work for on aw �is permit is California. �ssued,. as to becomes a to Workman's Comp Owner l ' ------ ------ Title . - - -- - ----------- --- By------------------(If other than owner) AO�DJEPA�RTMENT USE ONLY------ .DATE------------------- BUILDING PERINIT VSSUED - --------------------------------------DATE --- APPLTCATION ACCEPTED BY ---------------------- .;. -- - ADDITIONAL ----- ---- ---- - --- - --------------------��--- ---------------------------------------------------------------------------- COMMENTS--- r ------------------------------------------------- -------------------------------------------------------- ----------- --------------------------------------------- -7 --------------------------- Fina! Inspection by: SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M: -