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FOR OFFICE USE: APPLICATIO ..................... .. . N FOR SANITATION ON P LtM IT (Complete in Triplieatel Perm rt This Permit Expires T Year From Date issued Date Issued ..- ............. . _ Application is hereby made to the S n Joaquin local Health District for a permit,to construct and install the'' ork herein described.This,application is made in compliance wi County Ordinance No. 549.and existing Rules and Regulations .iOB ADDRESS/LOCATION /_.��c�:_• --- _.-.. ................... cT S'LI CENSUS TRA Owner's-Name i �~ n� f71� ..__... one *: i Address ...... Contractor's Narr,c i�si�J•-.r_ / �� -/ City - ! :•--, ' ..t.-Lrcense#/..� �� Phone installation will serve! Residence Apartment House Commercial�Troiler Court_ r Motel C]Other..- lP.._. ?'W?- 'Number.of livingunits:..../._... Number of bedrooms is -- -:.Garbage Grinder _. .. Lor Size' F. Water Supply: Public System and name .................. . _ ................._._....... Prlvate,� Character of soil to a depth of 3 feet. . Sand 0 Silt© Clay.❑ Peat© Sandy Loam CIay.Loam Hardpan Adobe ❑ Fill Material. if yes;type � i § y « pe .. (Plot plan, showing size of lot, locafiori of system In relation to vvells,-buildings; etc, must be placed on reverse side{ NEW INSTALLlITIONI ; ifto septic tank or seepage pit permitted If p//ublic sewer is available wsthin 200 feet,} `, "; + PACKAGE TREATMENT. f ] :sErriC TANK F ; Size.lfl tis Liquid Depth Capacity J�d D PTyYe Ce -�''�. Material..-S' .:. ••No Compartments G' r tXr .0 Distance to Weare t: V4fe[l ......:..-��__:a________"-•_--•..:Foundr,tion .line S l r . t LEACHING LINE No. of Lines ........ ;2-.. -. Length of each !'ne........ r Total Length f P { L)" Box _._....: .`Type Filter Material .... Depth.Filter Material* �.1-_�� :, J .01 Distance to nearest: Wel{ .:_..._:.5.d__---- Foundations ___:_./C _:. Pro a ine ' P �Y:L ` SEEPAGE PIT Depth ----4x. .r.__._ Diameter' ...... Number -_.. Rack Ftlled Yes r[ No F Water Table Depth ...-..... •• ..................... ock Size _ �. �.eY:.1 Distance to nearest:Well .............�a7 _.'...-.:.........Foundation Prop Line _. ' - , s l x REPAIR/ADDITION(Prev. Sanitc ' n Permit# _ Date ' I " Septi_Tank (Specify Requirements) ----------- f n •--•-•-----• -Dis oral"Field 5 eci Requirements) ................ --•'----------------- ..............•..------...._-•-•-•••--------•- ._....----•--------- a ........... .... .....................................-• ...................... } �� (Draw existing and required addition on reverse side) ' 1 hereby certify that I have prepared this;application and that the work will be done:in aCCerdance;wsth SaRkdeaquirt - ` Cainty Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local,Hen lfIt Disirid.Horite ownee er,liteti sed agents signature certifies the following: � - ., -'. . - :;' .,,. .-��• -:ice -� - Y 'SY"� "I certify:that in the performance of the work for which this permit is iss.red, I shall ne!iempToy..any pecten in such matlsier :`., as fa become subject to Workman's Compensation laws of California. Signed _..._ 1. n ' ..... ......... ... Owner" 4+ } BY -- :...-._- lGt ,_. (if other than owner) , Y FOR DEPARTMENT USE ONILY APPLICt,7tON ACCEPTED BY :.:.: -------------- �- DATE .�� BUILDING PERMIT ISSUED ...., :..._._=.-.__•.......... ..:.::........ . ......... ........DATE].:,- AIJDITIONAL'COMIAENTS .... . ....:.:...... ------------------- •-- -'--- ------- L ... �/j __-. - 1 Final Inspection b/: . :-.-t .�/Ar'y�iC.0 - ..................... Date J,. 'r^�� ....... SAN JOAQUIN LOCAL HEALTH DISTRICT E..H. 9 1-'68 Pev. 5M