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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ............ ......... r (Comptete in Triplicate) -Doti.Issued--J1//%76 fhls Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and Install the work herein described. This application is mode in,co/rnpliprnce with County Ordinance No. 5.49 and existing Rules and Regulations: :3OB ADDRESS/LOCATION .... a�l'�.`....� N. .... ...... . .. CENSUS TRACT ........................... Owner's Name ... -eta..... . ....... ... ...._................. ... ........ ......:...........Phone Address .... .. . . .4... ....... .:. ...city s r.:: ............ .... ......... Contractor's Name ,'t .:C :... ..:.:..............Licenso53:.` .. :.. Phone. Installation will serve: Residence(N Apartment House[] Commercial 13Traller Court 13 . 1 Motel ❑Other. ........................................ Number of living units:.:.�.....:. Number a1 bedrooms ..Z.....Garbage Grinder .......:.... WSise . .. . . - _-- ....:.:::.......:.:.:...........:..:.....:...... 1+mtp(, F Water Supply: Public System and name .......... ,.................•........................:... � Character of soil to a depth of 3 feet: Sand,�j'•..Slit 0--aaq-----Peat Q So*loam 0 Clay loam 99 Hardpan[� Adobe fltl iMatelriai ........ ..#f rI...........u..• .•..... ... � tc. awe be placed an re, t+eru side.) IPlot plan, showing also of lot. lacartlocation :o#_system inrelation-to wells, buildings. e NEW INSTALLATION: (No septic tarok or see age pit permitted if public sewer is available within 4A0 feet} f PACKAGE tltE,4TMEiV? f ] SEPTIC TANK ]P Sias. ........................................ Liclum Depth .......................... r,}� I . _. :..�. r . Caodty•' 1 ............. Type ................ Material-.. ..... .. No. CotnpairhnaMs �. Distance.to nearest: Well ................... ...:...:....:..Foundation.................. Prop. L...................... .. Bine........_:..... Total,Length . ..:.. .. ........ LEACHING EINE ( ]. No. of Lutes . Length . Box ( .•Type lifter Material ....:.......:. .Depth Filter Material ..:...:........ . ....................... y 'Distance to nearest, Well ........................ Foundation ....... ............ Property LMe......................... SEEPAGE PIT C 1 i epth ........... Diameter .. ..... Number ............................ Rock filled yes Q we ..�.-.... Sive Water Table Depth ................................................Rack ..... .............. . A - . , .:.. Distance to nearest: well .............. f=oundation ........ . Prop. tine 29PAIR/ADDITION(Prov. Sanitation Permits . . ... . ....... Date ................... --••1 Septic Tank (Specify Requirements). ...... . . i... ...........:. .......... ........_:...... -.............. Disposal Field pacify Require ants} ._ ....... - �- �1 r" `-` A` .. - . . .... � .. ...... .:'..:.UX- ` : ... -� r . ..... .. ._._.... ......... Draw existing and required addition on reverse side) .. .+ ... .. .. ' 1 hereby certify that I have prepared this application and that the work will be done In amordence with Sar JeogwiA _ I County Ordinances, State Laws, and Rules and Regulations of the Sart Jodqubt Local Health.Oistrict. deme nor- er Iteew sed agents signature certifies the following: "'Lcertlfy that in the performance of the work for which this pa IF", ued. i shall not employ arty~ Gs=ittelr rttoanar as to become subject to W n's Compensati laws of Calif A Signed ...... . BY ................ . -_. .........---....f...---._.... G�'.�` '-� Title ..t....._...._. ........... ......................... (if other than owner) t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _ ..-. . .... .. ..... ................................... DATE BUILDING PERMIT ISSUED .......... ........•..... ............. .................. • .............•............................. ADDITIONAL COMMENTS - y .... . _ - .... -- ••. ._...----. ----------------- .. � Pinot Inspection by: -- "`` .. .... .li�a EH 1.3 24 1.-68 Rev. SAN JOAQUiN LO L HEALTH DISTRICT 8/7h 3M � cor