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FOR OFFICE USE: APPLICATION iFOR SANITATION PERMIT 3 ; Permit No. ._.7l--`�- G�� ------- ----- ; ------------ - -- -- ---- � (Complete in Triplicate) Date Issued ---------- -------- ------------------- -- issued _ This Permit Expires l Year From Date Issue -I Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein - ------------ ------ ---------------------- - This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: described. Pp � -.-----CENSUS TRACT -------------------------- JOB ADDRESS/LOCATION V_,,x-9--p---- - 119 ----- one � - - -- -- ------------- - Owner's Name ._. - -- �--- -��••-�/°--- - - �Cit -------------------------------------------- L� � �_------------------ y:, /I�� Address '/ e ` � '� --- ----- -----.License # -.� ;- - - --- - Contractor's Name _ -. -- �- ��" ""-""" ---�--- - Installation will serve: Residence & rtment House❑ Commercial :❑Trailer Court l❑ Motel ❑Other -------------------------------------------- r Number of living units:__---- Number of bedrooms ----- Garbage Grinder Lot Size1"-4��x__n--�---------•--- Private ❑ Water Supply: Public System and name/. V—1� �-�`---gib "" "'"-- Sand Loam ❑ Clay Loam 22,-'Character of soil to a depth of 3 feet: Sand❑ Silt ElClay .❑ Peat EJ Sandy �. Hardpan ❑ Adobe E] Fill Material ._------------_- if yes,type ---------------------------- se side.}. !Plot plan, showing size of lot; location of system in relation to wells, buildings, etc. must be placed on rever P seepage pit permitted if public s wer is available within 200 feet,) j f NEW INSTALLATION: (No septic tank or �/ Liquid Depth PACKAGE TREATMENT { SEPTIC TANK'[7�.� S' e f U l �- Material-- �,r'-- No. Compartments "�------ Ca --- Capacity �� Type + Distance to nearest: Well --__- -� --------Foundation ------------ Prop. Line = � ---•--- 00, #/ LEACHING LINE I [ ----------- Len th of each cine:_ -------- Total Length o --- t No. of Lines ------------- g `t �� e th Filter Material --- ----------------------------- - ---- 'D' Box _ - Type Filter Material P ------ -- PropertyLine ------- ; Distan a to nearest: Well ___sem'"''-_ ----- Foundation f Rock Filled Yes 1`1a`❑ i De th �� --------- Diameter % Number ` SEEPAGE'PIT [ P Water Table Depth -------�` ----------------------- - Rock Size -___------ .�y. Foundation _ l ----------- Prop. Line ------_.. Distance to nearest: Well ---------------� -'------ REPAIRfADDITiON(Prev. Sanitation Permit# ------------------------------ p---------------------------- Septic ------------- - ----------- Septic Tank (Specify Requirements) --------------"---- -------------------------------- . Disposal Field (Specify Requirements) --------------------------------------------------------I----- I --- ------------------- .. -------------------------------------------- --------------------------------------------------- . .. .b; r ""----- ______________________lam-____.�-_---- ____ ____________-_____ ___-----___.._---___---_--__ -.-_-______---_ _._---__--_ ---" -------------------------- — �• , (Draw a sting andjequired addition on reverse si e ce with Son Joaquin I hereby certify that 1 have prepared this appli at and that the San Joaquin Local Health D' trctflt Homeowner or I ien- County Ordinances, State-Laws; and Rules and Regulations ;- f sed agents signature certifies the following: ermit is issued, I shall not employ any person--in-'such manner "I certify that in the performance of the work for which this p ` V/ as to became subject to Workman's Compen3ation laws of California." w . Signed ------ _T �. - Owner -, . �- Title -------- ------------- By ------------------------------------ j- (If r than owner) ' R .D ENT USE ONLY PATE - --- -------,��-7-- APPLICATION ACCEPTED BY ------ -- ------ DATE ---- ------- ------- BUILDING PERMIT ISSUED ____---:_-- - - ----------- ---------------- ADDITIONAL COMMENTS -------- - r ------------------ '---------------- , �¢- -------------------------------------------------- ------ - ----- - -'- ---- --- --- - ;------------------------------------- ---- ----- -- ------------------------------ --- ------------ ----------Date �f-' ' 7-_� Final Inspection bY- ----- - -- ------------------- - -- -- - - ---- "JOAQUIN LOCAL HEALTH DISTRICT G .a W o t_'68 5M