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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 75��z-- Permit No. ------- lComplete in Triplicate) y-7�°7y Date issued __-1-7 -__-_--_----- _-_ ------------- --------- ----------- ----- This Permit Expires 1 Year From Date Issued ----------------- - -------- ----- ---- ----,----- -----------made to the San Joaquin Local�� 7 .S�"r ; � , o to$ l Hedlth District fora permit to construct and install the work herein Application is hereby application is ► ha Sin m 1;a ith County Ordinance a 549 and1eexisting Rules and Regulations: described. This l% � ..' ,,` '*- CT -------------- _ . USR - JOB ADDRESS/LOCATION - Phone < E- Owner's Name a fVZ City -`J-`------------------- f�� Address - ------ -------------. -r--- ..... - - Phone-- --------- License -- Licens ______ Contractor's Name __ ___ _____ Residence ❑Aper#+hent-House❑ Commercial ':❑Trailer Court lnsfallation will serve: ❑- � -. — — Mote!- Other - _=- r--` _Garbage Grinder."----------- Lot Size ✓ - /�- = Number`of living units:.-.------- - Number of bedrao_msi ------- --------Private ❑ ': ; �, Water Supply: Public System and name ---------------- ------ Sand Loam Clay Loam Silt; Clay ❑ Peat❑ Y ❑ Character.-of soil to a depth of 3 feet: Sand's ❑W � i `� c Hardpan Adobe 9 i Fi11'Mater,ai __,-:------ l yes, type ------------- ------ e side.) size of lot, location of system in relation to wells, buildings, etc. must be placed on revers ;1 t [Plot plan, showing, NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet, I Sizei----- Ma-tre-rial l✓J�1.Ls_-- ----- Liquid Depth ----/Z1 PACAGE TREATMENT, SEPTIC TANK�Xts � No. Compar#men ` f� Capacity / sJo. Type i``°`--` Pro Line �L.� rn ! Distance to nearest: Well _______�-y^--• Foundation -----/ - p i Depth Filter Material --- Property ___-- 41-�®-----•----------- M~ LEACHING LINE ,Q(S No. of L•++nes _.-- -- -- - ---------- Length of each line-- --��C2----------- Total Length F Pro e � I 'D' Sox _-/---- --- Type Filter-Material ------ �'-- ------•Dep fL� -- p Y Distance to nearest: Well ________________________ Foundation _---___-- - ' rty Line. t Rock Filled Yes ❑ No _ Diameter Number ---------------------------- f De th ------- - ; SEEPAGE PIT [ ] P --- ------ ----- -�--- Watr'Ta_ble Depth -.` -- Rock Size -------------------------------- -------- =---- E --- ---:"------- --- Foundation • -------------- ---- Prop. Line -----------•---------- --•---------- t Distance to nearest: We • --.r:-. `. . Date ----------------------------------} ~ REPAIR/ADDITION(Prev. Sanitation Permit# ----------------------------------- --------------------------- / la - ----------------------------------------- -- Septic Tank (Specify Requirements)!--- - Q ----------- - ------------------ --------------------------- Disposal Field (Specify Requirements) --------- ? ------------- -------------------------------------- -------------------- ---------------- ------------�------------------------- ------------ ' --------------- --------------------------------------------- ------------------------ - -------------- - r (Draw existing and required addition on reverse side) l�ot the work will be ne in accor Sort Joaquin I hereby certify that I have prepared this application OnctionstoF the San Joaquin LocalpHe 1 h District. omancetowner or licen- County Ordinances, State Laws, and Rules and Regula sed agents signature certifies the following: erson in such manner "I certify that in the performance of the work for which this permit is issued, I shall not employ any p as to'become subject to Workman's Compensation laws of California." ------ Owner Signed _.. -------------------------- � Title (If other than owner) ' OR DEPARTMENT USE ONLY ----- --------------------------------------------- ------ ------- ----- DATE ------- - ---- - --- - --•------- APPL�ICATION ACCEPTED BY ---- -------- --- - ---=---DATE=__-----_----_------:------�:��- ------ BUiLD1N.G�PERMIT...155UED --___._.------- ------ -----------=----- ---------------------------------------------------------------------------------------- -----------•------ ADDITIONAL COMMENTS --------------- ----- --------------- -------------- ---------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------- - --- --- Date _ � - Final Inspect ion.b ---- - --- ---------- - --------- ------------------------ i SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M _ -