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t FOR OFFICE USE: ___._.9-_3 a ----- - -- APPLICAT#Old' FOR SANITATION PERMIT ------------------------------��- --------------- (Complete in Triplicate) Permit No: 7L./Qa 2- -;J --- ---- --- ---------- - --- --- ----�--- -------- --- - - -- This Permit Expires 1 Year From Date issued Date Issued7� ' -} Application is hereby made to the San Joaquin Local Health District fora described. This application is made in compliance with County Ordinance No. it t and str ' permit to construct and instal! the work herein JOB ADDgESS/LOC — existing Rules and Regulations. ON - g Owner's Name _ __ �1 -`--------------- ---- -CENSUS TRACT Address - ------------------------ --Phone Contractor's N me _ _- Y65;0�J6L�'� Cit ------------- Residence ----� 1 installation wiil serve: License#�� Phone Residence p, , partment House 0 Commercial:❑Tra;ler Court ;(] Motel Other'--------------------------- Number of living units:._._ ----- - ---- Number of bedrooms . , Water Supply: Public System and name Garbage Grinder Y_.. Lot Size _ -_ F -e---------------- Character of soil to a depth of 3 feet: Sand ❑ Silt.(] Cla Private�7( Y ❑ heat Sandy Loam Hardpan ❑ Clay Loam' P ❑ Adobe ❑, Fill Materia __-___- g .• y J. ----- If Yes, type ---------- ----------------- (Plot plan, showing size of lot, location of s stem in reldtion to wells, buildings, etc. mu NEW INSTALLATION: t(No septic taoo-nk or`seepage Pitt permitt cif public.sewer _must be placed on reverse side,) PACKAGE TREATMENT' ( � SEPTIC 6K�j . _.}. .- y� is available within 200 feet,]? a �� Ca acit .7 Size_ _- _ , ------ ------ Liquid De th P r✓ - TY - p f�'---•----•-- t/�- =------ ----- Material ' /� Distance to nearest:. V4/elj i '_0_No. -Compartments P "�---•----- LEACHING LINE ;7 -----------------Foundation No. of Lines '�- ---------- - Prop. Line i --------------------------�� Length of each line_ - � �----- - ' �--------------- ------ Total length_ D PDX �'� Type Filter MateriaJ� Z*W -Depth Filter Material Distance to nearest: Weil __ - ----------------------------------- SEEPAGE •-----------------------_-•__- SEEPAGE PIT (� ,�—s � -_ Foundation _� --- t •--� /�. Depth _ -'- Diameter 1`#perty Line - Number ---- _-_ ----- Rock°Filled Yes No Water Table De th ' P ------ ock 5iz R ` d to nearest: Wel! - �� ------------------ Distance( a-��------ ----------------Foundation 01 REPAIR/ADDITION Prev. Sanitation Permit# _______________ _ ----- Pro Line _%;P; Tank (Specify Requirements] _.--- ate ---------__- ,� ------ ------------- ----- Disposal Field (Specify R quirements}�-------------------- ------------- ----- - - --- --- --- ------ -------------------------------------- -------------- -------------------- - - --------------------------------------------I------------- ---------------------------------- (Drawexisting and required addition on reverse side) ' �� hereby certify that I havepreparedthis application and that the work wil be'done in County Ordinances State laws, and Rules and Regulations of the San Joaquihi Local Health District.x 4 �, accordance with San Joaquin sed agents signature certifies the following; "1 certify that in the performance o'f,the work For whit nct. Home owner or iieen- as to become subject to workman's Compensation laws of Ca •farit is i E. permit is issued, 1 sshall not employ any person in such manner Signed .... ------ _ ----------------- - i _ --- - --- ----------- EY ------------ --- --- - / - - -t-- Owner } (If of er than owner} �'- Title ___-: ' ---------------------- r APPLICATION ACCENTED 8Y --__ EPARTMEN USE ,ONLY �= BUILDING PERMIT ISSUED -- -- _ ADDITIONAL COMMEN l r --------- ------------------ f r �. = ----(Y------- f ------ DATE ------- -- --- r- -E � �� -QL-14-_ ----�'�- �[?, ,�Ir - ------ -- - --- _ rnal Inspection b f ----- _____________________________________________I--___._______-. ---- ------------------------------------------Date - AQUIN LOCAL HEALTH DISTRICT 7� --.-- -- �4 ! E. H. 9 1-'68 Rev. SM ',