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FOR OFFICE USE: "APPLICATION FOR SANITATION PERMIT M. � permit No: / 416n- /,486- f (Complete in Triplicate) f 0 ---------- ------- /!:3� �i- -- Date issued ----- --- -- �t 12— This Permit Expires 1 Year From Date issue Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein { F pP described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations. . --- �. _-T-0-20----- --- ----- - - _ _ CENSUS TRACT -------------------------- JOB --- ------ -------------- - ------------ ------------ ----- --- --- JOB ADDRESS/LOCATIONPhone ' 3 --------- Owner's Name - - City -- --- I-a� Address - -- -- ---- ----- ----- --- -' __ Phone ---- �. License ' ----- ----- ----- -- --------- ------ - - - ------ --- - -= -- ---------------- Contractor's Name ------------ --- � -- - - Residence ❑ Apartment House�❑ Commercial:❑Trailer Court ,❑ Installation will serve: t --Motel ❑Other ------------------------------------------- Garbage Grinder /t��---- Lot Size ____ -- - ----- ----------- Number of living units:-'- ---- Number of bedrooms _-- -- --- private ------------ -- ---------------- --------------------- - Water Supply: Public System and name --------- --------------- -E]Loam Clay Loam ❑ , Character of soil to a depth of 3 feet N-Sand'❑ Silt❑ Clay ❑ Peat E] Sandy t t ---- Hardpan C] Adobe F;I1 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.) # 1 ! e i# permitted if public sewer ;s available within 200 feet,) �i NEW INSTALLATION: (No septic tank or seepag p P Liquid Depth -------------------------- SEPTIC TANK:[ I Size------------------------- PACKAGE TREATMENT [ 1 r -- No. Compartments ----- Capacity -- ----- ---- ------ - Type - ----- ------ ---- Material------------------ � Distance to nearest: Well .__- ----------------------Foundation __._.-- Prop. Lane .___------------• LEACHING LINE [ } Length of each line---------------- Total Length ----------------------------- LEACHING ------------------•------- ; ',No. of Lines .. ----- - --- �--- �, -- -------------• - ------ Filter Material _--- . . �__De th Filter Material ------------- -- -- b' Box Type r ,------------ P - `� ' ------ Foundation - --- ----- ._ Property Line ------------•----------- ;Distance to nearest: - ---------------- INo 0 _ - Diameter !--------------- Number -_------------- -- Rock Filled Yes C][ SE EPAGE PIT [ 1 Depth I l - i ,Water Table Depth -------- ----------- ---------------- ------------ Rock Size - --------------- ------ I prop. Line --------- ----------- Distance to nearest: Well -----------,-- Foundation __------------- P fl-vf'` -' f `._,_:_Date ---------- ) r+'IfEPAIR/ADDITION,(Pre-Q. Sanitation Permit# - '------ - t c" - ------ r----- -- k ----------- t, Septic Tank (:Specify Requirements) Dispose5l Field (Specif Requirements) --------- k ------------------------!------------------ ------ r / [ ZA-_��'---lel--- - - --------- l --------------- i --------- ------------------------------------------------ ---------------- ----------------------------- -------------- N x 1 r`-- -;------------- 1 (Draw existing and required addition on reverse side) rk will he.�.. o h Son Joaquin I`hereby certify that 1 have prepared this application efihat the woof the San Joaquin Local District. ce `t o Home owner or !cen- c� County Ordinances, State Laws, and,Rules Regulations sed agents signature,certifies the following: arson in such manner "I certify that in the performanc6 of.the.,work for which this permit is issued, l shall not employ any_p i as to become subject to Workman's Compensation laws of California." bj Owner Signed t sTitle ------ = By ---- --------- --- __492,x- I (If other t owner) FORD ARTMENT USE ONLY 4 DATE _ ----� APPLICATION ACCEPTED BY `' ----------= -DATE -------------•-------- BUILDING PERMIT ISSUED _._--- _- ADDITI N L CO ENTS �� ° ------"-z �'"_'' c` ` -L� _ Nin - _ _ - ----'--- io /' 1�, - ---------------------------------------------------- ------ ------------------------------------ ------- i -------------- ---- -- iQ __6�" ----------- ---- ------- ------- ------- -------------------- --------- ----------------------------- -------------- Date -- ------ I ------------------------------------------------ -- ------------------------------ Final Inspection b ------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT F. H. 9 1-'68 Rev. 5M.