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FOR OFFICE WE. APPLICATION FOR SANITATION PERMIT Permit No. --------------------- ----------------------------------- (complete in Triplicate) n Date issued ---------------------- ------------------ ---------------- This Permit Expires I Your From Date Issued strict for a permit to construct and install the work herein Application is hereby made to the San Joaquin Local Health Di is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: described, This application __-CENSUS TRACT ----- ........... ---(.17H JOB ADDRESS/1-0-CATION# -------- --------- --- Phone --------------------------- 00K --------------------------------- Owner's Name . ....... B7 11F---------- - I 31- 4A Ax ---------------- City ----- '------------------------------------------------- Address -------------------------------I----------------- Address ----------------- ------- Phone ------------------------------ Contractor's Name ----------------------- --- --------------------------- -------License # ----------------- Residence ��tment House[] Commercial:[]Trailer Court '[1 Installation will serve. Motel 0 Other -306 G---a--r----- -d-e-r-A10---- Lot Size r of living units:------ Number of bedrooms ba Ghn - --- I----- �� ---------Private [�R� Number Water Supply: Public System and. --------------- ------ - - !t Q. --qlay Q. Peat F1, Sandy Loam.-El, Clay Loam 0 Character of soil to a depth of!3 feet. Sand'F�i Vt--erF0I-- 19--Ifye�s-,type----------------------------- Hardpan h Adobe-F] I Fill-M must be plaqed on reverse side.) ln'rela'tioln to wells, builoir�as,, ;Plot plan, showing size of lot-,,, location of system .4 4 9tc!;, tted if public sewer is av�a)able within 200 feet,) I NEW INSTALLATION: (No septic tank or s pit permi -Z� ------- Liquid Depth ------ SEPTIC TANK'[ I _ Y--'-- -2, PACKAGE TREATMENT [ I 1� I Material Z `N C part ments ------.-•.------- Capacity - -------- 0.1 om ell ---- Prop. Line ----- Distance ----- Distance to nearest- W ............ Foundation 14910----------- Total Length --------- Z�— LEACHING LINE Ve' No. of Lines --------- Length of each lin-e ---- ------- `7--17 -ricid 17 i R - Depth Filter Mate ------- --- -------- J-0-0 _ __Dep 'D' Box/)�7-5 Type�.Filter-.Mate.ric Line --- 4� /0------------- Property, Li ------ 570----- foundation I t Rock Filled Yes No 0- SEEPAGE PIT bepth -------------------- Diameter ---------------- Numbe A Table Depth ----------------------------------- ------------Rock Size ------------------------------ Water 17! 1 I - 1 \�- dation ---------------m�---- Prop. Line -------------------- t6-r) ----------------Foun Distance e t I ---------------------------- I - - --------.Date ---------------- ------------ n , I - ------ ------) ----------- --------- REPAIR/ADDITION Septic Tank-(Specify Requiremens -------- - ---------------- - - - - -------- ------ V � - Disposal Field (Specify Req6irements) - I ---------------------- --- ---------- --------------- ------- -----'-------------------------------------------------------------- -- VNt ----------------------A---- --------- --------- ----------------------- ----------------- ---- (Draw existing and required addition on reverse side) and that the work will be done in accordance with Son Joaquin I herebyliertify th6t I have prepared this application Local Health District. Home owner or licen- A County Ordinances! State Laws, and-Rules and Regulations of the San Joaquin sed agent's signature certifies the following: fs,liwfl-Iii�t employ any person in such.manner 1.1 certify�that in tli�.pi;R6- ,mancie�.of-theWiirk--for wlilch--th6-permit ls-i;iz�i4r as to becdme subject to Workman's compensation laws of California." Owner Signed ----------------------------------------- -------------- --------- ------ Title --- ------- .. - -------------------- --------------- By FOR DEPARTMENT USE ONLY ATE ---------- --- ---- TON ACC DATE ---- -------------------------------------- APP Cl 6�-I- —H"OfE ------- BUILDING PERMIT ISSUED.:-_.------- ------------------------------------------- - -J- I— I --- I--------- ------ ADDIYIO-qAC-C(5-M--ME,-N-Ts ---------- --------------------------- ------ ----- -------------------------------------------------- ------ - - ------ ------f -------------------- ----- ------1-�----------- ------------------------- --------------------------------------------------------------------------------------- - - --0----------- ---------, --- --- -- --- - --- U� Date -- Final Ins ct!On �,h SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M