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FOR OFFICE USE: gppLICATIONFORaaSANITATION PERMIT ��_�f _N, „ Permit No. I --- --- - kr (Complete in Triplicate) ---- ---------- .... ,. Date Issued `' °*"�" This Permit Expires 1 Year From Date Issued �y ie •Y-S ._______ k Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein F y described. This ereb,application i ade in compliance with County Ordinance No. 549 and xi�g Rules and Regu ations: 6 SUS TRACT ------ --------- JOB ADDRESS/LOCATION das�x�1 Ph C;. one ------------------------------------ Owner's Name _'_ f-0, --- City �S'r� Address. 6�� '� - Phone- �._ �,1�•4- -�rf-�-�;''�-C----License # ��0�9 ---- - � Contractor's Name _.-- enc A artment House[ Commercial:[]Trailer Court Installation Will serve: Rest * p Motel - Other(-------------------------- ----------------- ❑ , AI ______Garbage Grinde Jvv--- Lot Size --/v/-ov - Number of-living units:____/---- Number of bedroo ---------- - ---------Private ❑ Water SuppFY+Public System and—nam,j _ Clay Loam ❑ c' y Peat ❑ Sandy Loam Y Character of soil to a depth of 3 feet: -------- Son Silt❑ CIO ❑ Hcirdpan,` ] Adobe Fill Material _----------- 1 Yes, type ----- -------- ----- ------ (Plot plan, showing size.of lot, locatio of system in relation to wells, buildings, etc. must be placed on reverse side.] (� NEW INSTALLATION: (No septic flank or seepage pit permitted if public ewer as ava Fable within 200 feet,) t w ..., . 1 9 t] --------- Liquid Depth --------------- SEPTIC TANK --- -- PACKAGE TREATMENT [ ] DD No. Compartments - --- 1 Type [ �- a Material_� rx - - dw . Capacity��- ------ Yp - , _- _--Foundation _'Ito-f----------- Pro p• Line ------- Distance to nearest: Weil -- - 4 } -- p ---,- - -- Total Length i ----- � � Lengh-of each line_--_.- LEACHING LINE I No. ofLines ___2- --------- rial+ `r -Depth Filter Material --- - --- - --- ---------------_ •--�• -- J:�Box._. - Type =filter Mote �' Line -------- Distance _ _.-_ Property --------------- Distance to nearest: We11C�-W--------- No . � / Number ---------------- ------ --- Rock Filled Yes ❑ �❑ ------------------- Diameter --------------- SEEPAGE PI [ ] Depth # Line.� _. .�. ,.,.. �. -• `------Rock Size -------------------------------- 4 -W6ter Table Depih r ------ ---------------- ---- � ,.- Pro Li --------------•------- � Distance to nearest: Well --------- --------------------- -_.--Foundation ------------------ p REPAIR/ADDITION(Prev. Sanitation erm, - Date --------------------------------- ) Septic Tank (Specify Requirements ----------------- - ------------------------------ Disposal Field (Specify Requirements) -------------------------------•- I ------------------- ----------------- ---------------------------- ---------------------------------- :--- •------ -- -- -_----------------------- -------------------------- --------------------- ------------------------- (Draw existing and required addition on reverse sidey [ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin es and Regulations of the San Joaquin Local Health District. Home owner or licen- County Ordinances, State Laws, and Rul sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner i as to bec iect t Workman' Compens tion law4f California." fit Utz -- ---- Owner Signer `s ' Title (If other than o�ner) FOR DEPARTMENT USE ONLY �..�,. y ---------------- Y[ -- ----------- APPLICATION ACCEPTED BY - ='I -! - -- --- ------ -- -- --------------- --------------DATE ----------------------------------- ------- BUILDINGPERMIT ISSUED - ------------------------ --------------------------------------- ---- ----------------------------- ---------------- ---------------------- ------ --- ------- ----------- ADDITIONAL COMMENTS -- --------------- ------------------- --------------------------- ------------------- ------ - ---------------- -------------------------------------------------------------------------------- -- --- ----------------------------------------------------------- ----- ---- --- --- - _.Date ---- ---------------------------- --- - ------ Final inspection b �---- SAN JOAQUIN LOCAL HEALTH DISTRICT ' r E. H, 9 1-'68 Rev. 5M.