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n F�c7R OFFICE USE: ' - APPLICATION FOR SANITA ION PERMIT � � 57�� -._- Permit No: ..................... ......:_ ......... ......................................... (Complete in Triplicate) ! • ` ..................... ..... . ff Date Issued ...7.J :.• i .1 iI This Permit Expires 1 Year From Date issued --•.__._...---•..__......_. i Application is hereby madel�to the Son Joaquin Local Health District for a permit to construct and install the work herein k described.lThis applic,t+ n;'s�T6W64-4-Cf4 de,lblSmUlg� ' h County 0A7n� Io. 549 and existing Rules and Regulations: ff-- N r � .............CENSUS TRAGI' ..---._....... JOB ADDRESS/LOCATION..- ...._.....x_......`� ..._....:... !f ell..T.l �. !.-7-• T .�s'! r ....Phone .... Owner's Name . .. i ................:. City .._ .......................... Address ........................ E P rs Name II ---...._--•------------- - -------••..._...License # ......:..:...... ......: one ................... -....... Contracto, . Installation will serve: d� esidence Apartment House;❑ Commercial ❑Trailer Court 0' #. r :l Motel ❑ Other ..._ •..------- ------- i ...., Number of Jiving uni s:__.._M_ mbar of bedrooms _......._.__Garbage Grinder ._._..._:...RLot Size ---------- -----------•-• �� '•• �. ...... Private ❑ Water Suppiy: Public System and name ... 3 ^ ------- } ) • Character'of soil to a depth;of 3 feet: Sand El Silt❑ .-Clay-t❑ Peat[] Sandy Loam Clay Loam ❑ Hardpan ❑ Adobe'❑ ,Fill Material ............ If yes, type .........-------- 4 (Plot plan, showing size of lot, location of. system in relation to wells, buildings,. etc. must be placed on reverse side.) i L NEW INSTALLATION: (N'o septic tank or seepage pit permitted if public sewer isavailablewithin 200 feet,) PACKAGE. TREATMENT ,i� SEPTIC TANK:[ .............. --•--:e. .,--- -• ... .... Liquid Depth� ............................ . ..---•-•.-.•.•.. ...............Material...._. No. Compartments Capacity ................. Type --••-----... . dk. ' � at on Distance to nearest: Well .........•.--•.•---�---•-----Found .. ---- .............. Prop. L ine . .. IIffII , Total Length _z1v t LEACHING LINE -N� . of Lines U ,Length of each Iine�D� ^ -..__ „i .__. r - / �. p h iter aterial ,.�......................... + I?' Box ..1 . Typo Filter-Material / �. .. E Foundation::....:..:...... ...: Property Line Distance to nearest•.Well ................... �� . .r ��i 4 Diameter ,Number. `._.._.`--•.-.__.... Rock Filled, ;Yes No ❑ SEEPAGE'.PIT [ l Depth :...... i� I� ........RockSize .........•-•-••----Water Table Depth ._ Foundation ..... 'Prop: Line .............---•----- D�stance to nearest: Well ..................................... .. t, ••• . .• ih n Permit;# ` •_•• 5�'-�•- Date ..�........... -.............. � y REPAIR/ADDITION(Prev. Sanitaria Septic Tank {Specify Re:ukementIO --------------------------- ....................... :...:._.-_ 4 . i Disposal...Field (Specify; equirem�#s ...............:....:...,_�.�- �.-�-�............_........................................ r ' R , l �- _ ---------- ............... •-------•---------- ....... .....__...-• --- �i �Ip F ------------------------ -------------••-------__....--..----•-. - ._.... f II N (Draw existing and required addition on reverse side) . I hereby certify that thisfapplication and that the work will be done°in accordance with San Joaquin I have prepared County Ordinances, State��laws; and Rules and Regulations of the San Joaquin Local health District. Home owner or liten- sed ageeits signature tertifles the following: "1 certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to beeome subi t to Workman's Co ensotion laws of California." Signed .. ....... owner -- - --- .. -- --..............z .._.._...__...._._.... ----- Title..............By (If . other than owner) DEPARTMENT USEONLY ' 3 � . w �y ...... APPLICATION ACCEPTED[BY . --._...... -- • •.................•-•-•• DATE .....rr' 1l. � DATE --......_r_...:.:. ................ BUILDING PERMIT ISSUED .................................................T,::t.. BUILDING __......... = .:.., - ` _- ... _..:....5--....°._...t.........................•:....:............_.._._........, ADDITIONAL COMMENTS ........................•-----... ...... _....... .....----- ,. } q °I' [ --•-• ---- ------------------ - ------- .....-------•-•• .... ...... I .. Q t f.._{ ... I. - .... ..................--------------........ __• _ ...... it '1_..... _ `-1 ---------- .. . . . Date ,. Final Ins action b !I ..�...h[l..l._. . . ..... •-----•..... .-- . . ................ II + SAN JOAO IN LOCAL HEALTH DIS ICT i. 7/72 3-H k :'.c Li 1.3 24 1_,An Dow 5M _. __.