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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No.. -------7--------- --------------1--------------------- (complete in Triplicate) Date issued - ------------ --------------------------------- This Permit Expires 1 Year From Date Issued -------- 0( 3 — 11 the work herein Application is hereby made to the San Joaquin Local Health District for a per'mit to construct and insto described. This application is madg! i!n compliance with County Ordinance No. 549 and existing Rules and Regulations: J ' ' F-. (,)no ts g-li -. � e Z�o —,f -t— J4P --'- AENS' US TRACT ------ ------- 3 y1b --e-—- ---------- JOB ADDRESS/LOCATION ---- - ------- -- I-A Phone - ---------------------------------- ---- --------------------------- ---------- -----A . Ci (44-L"W ------ -01,jo---------------------- Owner's Name -- ----------- -- ------- -- -- --- ------- Address ------ -------------- y --- -------0-7-46 ------- ------- # Phone ------------------------------ -- --- -------- ------- --------------License ------- --- ------- --------- Contractor's Name --- b1XI-�-, - installation will serve: Residence EE/Apartment House,[] Commercial :F-ITrailer Court E] Motel F-1 Other -------------------------------------------- � 2-0 Number of living units------- Number of bedrooms --3-------Garba-ge Grinder ------------ Lot Size --- ---------------- - ------------ ------------Private Water Supply: Public System and name ---------------------- -------------------------------------- ---------------- Silt.C] Clay E] �eat E] Sandy La`o`m`-��Iay Loom [I Character of soil to a depth of 3 fe&t:" Sand'C] terial ------------ If jes, type ---------------------------- Hardpan F-1 Adobe,o Fill Ma stem in relation ta wells, buildings, etc. must be placed on reverse sicle.)� (Plot plan, showing size of lot, location of sy I �sewer is.available within 200 feet) pa e pit blic NEW INSTALLATION: (No septic tank or see permi ec i .pu id ------------------ Liqu Depth --------------------- PACKAGE TREATMENT SEPTIC TANKf Size-TA-1 nts ----------- Capacity- ---------- O�Material --- 1o6--j Type No. Compartme --- --------------- ---/D ------- Prop. Line --4;�-------------- - 1D`igfa—Hc-e:to. nearel- Well -----------------Foundation --- ------ jcmi If -7 ... 9 0---70- Total Len th ---��YR------------- --------------- Length of each line- LEACHING LINE (11"/No. of Lines ----- Material ------------ 'D' Box Type Filter Material Filter ------------------ Line ----S-------------------- Distance nearest: Well ------ --Forunclation -1-0------------------ Property Number ----------------------------- Yes C] No 01 Rock Filled SEEPAGE PIT Depth -- --------------- Diameter ------ I— Water T6ble'"Depth ------------------------------------------------Rock Size line -------------- -------- I ----- --------------- Prop. Distance.to nearest-, Well ----------------------------------------Foundation Date --------------------------- ------ REPAIIR/�613117110N(Prev. Sanitation Permit# i.� ' :,-. -A -------------------------------------------------------------- ------------------------ Septic Tank (Specify Requirem6nts) ----- ----------------------------------------- ------------ --�'Disposal Field (Specify Requirements) ----------- --------------- ------------------------------------------------------------------------------ ---- ----- - -----!�,------------------- ---------------- --- -------------------- -------------------------------------------------------- ----------I---------- ----------------- ----------------------------------------------------------------------- ----------------------- ---------- -------- -------------------------------------- (Draw existing and required'addition.on reverse side), .1 that the work will be clon'e in accordance with Son Joaquin. I her�by certify that I have prepared this application and i - ions of.the San Joaquin Local Health District. Home owner�or licen County-ordinances-,-State-Laws,!and Rules,and Regulati sed agents signature certifies the following: ffl not employ any person in suich manner e of the�work for which this permit is issued, I sha "I certify that in the performanc - -- - - -1-_. _f - —..�s 64,o, —ensation Ilaws of Cali ornia. t to 111�v oi� 1; m as to become suKect to or man CC;m _4 owner Signed ---- - ---------- jitle- --------------------- . . .. .. .... --------------------- --------- - --- - ------------------------ ---By- ---- ---- --- ----- (if other than owr�er) FOR DEPAATNIENT USE ONLY ------------- DATE ------------------------ APPLICATION ACCEI� I ---------------- --------------------DATE ------------- ----------------------------- BUILDINGPERMIT ISSUED ------------------------------------------------------------------------------------ ------------------------------------------- ADDITIONALCOMMENTS - ------------------------------------------------------------------------------------ --------�r -------------------------- ---------------------- ------------------------------------------------------------------ ----------- ---------- ----- --------- -------------------- --------------- ------------------------- ---------------------------------------------- -------------------------------------------------------------------- - ------------------------------------------------------------------------------------------;9- ----- ----- ------------------ ------- ---------------------------------------------------------------------- ------- ---- --- -- ---- ----- Final Ins pe ct ion by: `-"'SAN JOAQUINAOCAL HEALTH DISTRICT 4'1k�r: E. H. 9 1-'68 Rev. 5M,