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FOR OFFICE USE: I APPLICATION FOR SANITATION PERMIT 1i (Complete in Triplicate) Permit No, -- Y_. --- - ---- -- -- j — -- - te��,- "-- r�S This Permit Expires 1 Year From Date Issued 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 made in compliance with County Ordinance No. 549-and existing Rules and Regulations: ii _ JOB ADDRESS/LOC TION .-- -- -------- ---_ } - --- _,.� - -' _�- _ SCENSUS TRACT ! ------ Owner's Name ------ !_L _�:P `- 4�_1 �'__` ` i ---------- -------Phone- -- - ----- -------- Address -------- �-t �- 3(?�_, � z ' -- ti:;..-----�- -------. City -- -.- Contractor's --------------------•-- Name _ WJAtt-I_p-�_____C64 -------C�,---_I----- -- License # - ----- Phone -------- Installation will serve: Residence�rtmen ,House Commercial f Trailer Court 0 E Motel ❑Other ------------------------------ E Number of living units:------ Number of bedrooms ___ i _____Garbage Grinder _1��?.__ Lot Sze _�QQ-_�--_rQ�--�_----_------ Water Supply: Public System and name _.__ Y ' W 1 PP Y Y _ � �� "-�I- - - --------------------------=------ ---Private ❑ f Character of soil to d-depth of 3 feet: _Sand'Q__Si lt❑ Clay ❑' peat❑ Sandy L am`�/Cla Loam - L'� Y ❑ Hardpan ❑ Adobe'0 Fill Material JVP---P--- If yes, type ------------------ _ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc, must be placedon reverse side.) NEW INSTALLATION: (Na septic tank or seepage pit permitted if public sewer is available within 200 feet,} PACKAGE TREATMENT --_~SFpT1C TANK, --- Capacity i P tY �� ------ TYpeQt�f _C`� _ Material No. Compartments ;-7- Distance to nearest: Well ------_� -_ __ 1 s )� Length o each nine Fo Son To ' P i m a LEACHING LINE Na. of Lines ___________ __ % Pra Line _______ __..----__ Ir, r .�� a! Length, _f -TY . r-Material^- =De th Filter Materid)l f' Distance to nearest: Well ___-_- __- Foundation ) -j Property Line ----- E/ SEEPAGE PITT ] Depth -----1-------------- Diameter ---------------- Number]-I---------- i Rock Filled Yes [D No (3 Water Table Depth ----------------------------------------- 1sj ock Size - Distance to nearest: Well --------------------�"-'-�-^?__- Foundation -------------- 1--- Prop..Line ---------------------- REPAIR/ADDITION ------•--•- REPAIR/ADDITION(Prev. Sanitation Permit# _._____.-_________- '"""—�-------- pate Septic Tank (Specify Requirements) - 1 \� ---------------- -- ------------------------------------- ; J ----- ------ •------------ Disposal Field {Specify Requirements) ---•---------------l-___----- --------------- ------ 1--- { �_ ----- • ---------------------------------- --- -- ' --- - --------- --- - - - f " - g . q P ___ ___ _ _______ prepared Draw a Psttin and required addition on reve ----------------------- - -- -�-- - - rse side) I hereby certify that I have this application and that the work County Ordinances, State Laws, and Rules and Regulations of tWilli be done in 'accordan'ce with San Joaquin he San Joaquin Local Health District! Nome owner or licen- sed agents signature certifies the following: "I certify.that, in the performance of the'rvork for which this permit is issued, i shall not employ any 1person in such manner as to becomei u ct or a m ensation laws of California." I Signe r --- --- ------------------------------------------ Owner BY ---------------------- ----------------------- Titie -------- ------- 10f other than owner) -] 1- I FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ,-_C} ----------------------- --------- ---. DATE a BU I LD IIVP ER'lU4'IT�I SSL7 E D `_: -------------- __.-,---- Da4FE-- - - ADDITIONAL COMMENTS - ----- - - -- - �� C<t ---- - - ._ - -- -------- - --- ------ --- --- ------------------------------------ -------------- -- ------ ----- - -- --- --- ---- -------- -- - -- ------------ -p-e--- ----------- ___ a Final Inspe : . - 7 SAN JOAQUIN LOCAL HEALTH ' DISTRICT ------------ --------Date ----------- ------- ----- �- =------- D15TRICT E. H. 9 1-'68 Rev. 5M