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FOR OFFICE USE: ICATIOIV FOR SANITATION P PERMIT -- E Permit No. .--=--- '---- ------- (complete in Tri Triplicate) Date Issued __.....`.-..- -----• , - . This Permit Expires 1 Year From ate issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the workherein., pp application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: described. This app CENSUS TRACT __..... -. �� JOB ADDRESS/LOCATION "_L_(v. t ---------- e !�'� ' " - - -` .Phone ------------------------------------- owner's --- ---' ---'- ----------- -'---- Owner's NameA:11110 -`--------------------------------------- --- -------- 114-4"- ' ----- City --------------------------------- Address ------------------------------- Address - ---- -' Phone ------------------------------ ---------- License # ------- -------- Contractor's Name----- -------------------- Installation will serve: Residence ❑ Apartment House-n Commercial F❑Trailer Court l Motel ❑ Other . ------------------------------------ Number of living units-_ -j -Number of bedrooms .-. ..--.Garbage Grincler- --------. _ Lot Size ---. 9 lam-G �` i9 • Private ❑ Water Supply: Public System and name --------- -�'� :-I✓Jtt-.- - ClayLoam El Character of soil to a depth of 3 feet: Sand`[Silt Cl Clay ❑ Peat❑ Sandy Loam E] Hardpan ❑ Adobe .0 Fill Material ........ .. if yes,type --------- --------------- Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or see pit permitted if public sewer is available within 200 feet, ��fV-, " Liquid Depth PACKAGE TREATMENT ] SEPTICdK�( Size----1fX �O l ► Yp °{ _.-W)� #Mciterial- i � � No. Compartments _-,•2-----------=---• Cdpaaty.l .. T e --- Pro Line . � ---------- Distance to nearest: Well MdN2------------------------Foundation ...-..._ p f IZGa' �" - Total Length --- ----- ------------------ i _______--- Length of each line---- ---�--- "- - ---- .� LEACHING LINE [yY No. of Lines .:- - .t`��` T e Filter Material �'��--- ------Depth Filter Material ---,lei'-�-- ------�---------'""""-`"-" 'D' Box ---- -- Yp l -2 1___ Distance to nearest: Well =^��'^e---__------'Foundation .-'z.v--------------- Property Line Dia Number Rock Filled Yes ❑ No ❑ Depth meter -------------- I SEEPAGE L 1 ---'- - --- - � Rock Size -------------------------------- �. Water Table Depth --- --.-- ----- ----- ----------------=------- Pro Line Distance to nearest: Well -------- -----4- ----- --- f ----�------ ----- '---- .Date ---------------------------------- REPAIR/ADDITION -- ------------------------------1 REPAIR/ADDITION(Prev. Sanitation Permit# -------- ------ "-_----------- + l L ."". Septic Tank (Specify Requirements) ------------ -------------------------- Disposal Field (Specify Requirements) -- ----- - ------------- ----- ---- ----------------------------------------------------- - - - - - -- ------------------ ------ ------ --- - (Draw existing and required addition on reverse I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin r , and Rules and Regulations of the`San Joaquin Local Health District. Home owner or licen- County Ordinances, State Laws sed agents signature certifies the following: erson in such manner "1 certify that in the performance of the work for which this permit is issued, I shall not employ any p as to beco ubject to Work an"s ensation laws of California." ------------ - Owner Signed - ------ ------ _ ----- -- --- Title -- -- ------ ----- -------------------- - - ------------------ ---------- i BY (If other than owner) FOR .DEPARTMENT USE ONLY - fDATE _..- ---------------'-- APPLICATION ACCEPTED BY ----- ---OPY 0��4,------------- - --l-- -��- DATE -------------------------- ---- ------' --- BUILDING PERMIT ISSUED - .�.-.1 . �.,ei � ' ADDITIONAL COMMENTS - �3� 'Srt`"" '"' 11__ �✓ �/04.1 G►let � � �:.rsCtT'.Yreti s�3-rr• � ff ------ ---- --------------- -------' .+ --------- --------------- ----' ----- ----'----------------------------------------------- -- -------------------------------- -------------- --------- E ------------ - --------------Date ------•--------------------------- -------- Final Inspection by- ------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT F H_ 9 1-'68 Rev. 5M.