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r � FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT _/off v 1 Permit No. ...7.�...- -_.•-.• .............................. (Complete in Triplicate) Date Issued .1�:'�.. _ ............................. . This Permit Expires 1 Year From oaf*issued Application is hereby mode to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application N�5� a xisting Ru Regulations: is made in compliance with County Ordinances k fl JOB ADDRESS/LOCATION �... ......... . Z-�� T D[ f t Phone .,........ Owner's Name �y 6�' ...........City ...�N `--••.. •...................... Address p ..........:.................... _ � , - "` =License # . +� a � ? '°'�!�• Contractor's Name ........... .... . • -• ...... • .: Residence Apartment House�J Commercia railer Court installotion will serve: Motel ❑Other :..... .. ....... . Number of living units:._-.1.._. Number of bedrooms •••�.Oarboge Grinder. lot Size .... ••--=-- .private Water Supply: Public System and name .....................•-•..._.. ........................ - _. .__...... Peat Sandy Loam Clay Loam❑ Character of soil to-a depth of 3 feet: Sand❑ s Silt 0 Clay ❑ ❑ T ' Hardpan Q Adobe_( Fill Material .-:._...... if yes.type.---•.---•••---. 4 (Plot plan, showing size of lot, location of system in relation.to wells, buildings, etc. mus fi.be placed on reverse side. I ' NEW INSTALLATION: (No septic tank-or see a pit permitted if��p�blit sewer is available within 400 feet y SEPTIC TANK Siza... �,rt�.- -�r+--•-` .liquid Depth ........... .- ? PACKAGE TREATMENT [ I 3 ' No. Com ortments r�'"� ••.. Capacity "c4.d..... Type- Material. ��rv'-C...< < ..._...... . .. :._Foundation .....L-P..--..__»PProp. Ung .. .. Distance to nearest: Well -•• 6 e, .. Length of each line---.: a . -.. Total Length - • �" [ No. of lines ..:... . ...... ..•-- '�-- 'ACHING LINE � . ..•`�• �� 4 .D' Box ... ----- TYPe Filter Material :..:5. �...Depth Filter Material ... ...».. 1. . Property Line ...r5.....::........ Distance to nebrest: Well .:.... P._.�:.::.... Foundation + Diameter Number ............ Rock Filled Yes (] No 0' , SEEPAGE PIT [ j Depth .................... .............._ Water Table.Depth _ =---.M. ........Rock.Size .._........................._. t nearest: Well Foundation ...._.» (rep. Line -.»_.. Distance to ...........•_...... REPAIR/ADDITION(Prev. Sanitation"Permit# ........... -»-•......................... Date .....................»..... - - Septic Tank (Specify Requirements) .................»........._.... --..;.............. ---».............» ..-..�-.r.._y._.._..:...�.......... .. _..:........._ Disposal Field (Specify Requirements) ...............»-----:..........v : ........ .... - :..... --_............................ _.-► I ... ............. ................... .._.................._... .. .. ......... ............................................ . '........._.._...._..__....:�_... ...••0__.....�_.._....` I .:.-_•__•..........................:....r._....:........__. .. _.. ..... ...._. _........ _ (Draw existing and required addition on reverse side) I hereby certify that 1 have prepared this application and thot'the work will be done in accordance with San Joaquin egulations of the San Joaquin local Health District. Hem* owner or lice n County Ordinances. State laws, and Rules and R } sed agents signature certifies the fotiewing: nen in such manner.. j "I certify that in the performance of the work for which this permit is issued, I shall not employ any M t as to become subject to Workman's.Compensation laws of Califernia." ; Signed . . :.......... . . .•-- .--• Owner -� BY. ............. . e,;!!--aw % ...... Title - ti...........................: ....................................... (if other than owner) - 'FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ,,tom :............................... ...._........» DATE ............ .........................».. BUILDING PERMIT ISSUED .............-----:-...•_ ------- - ..rW. . ._....... _..._DATE ....._ ...... ADDITIONAL COMMENTS ............. ......... . .._.....: :."' .: ...........................................................: f .: .4......':..:.............:.....: '........... .......... ..........»............... _ .............................. ....................................................... _ - _ :. _.... . _...... ......... ` e�. ......... .j. .. .:........... ................ ..........................lktfe,l l-" Final Inspection by: .............:....... .. .. •• . ..... .. .. ..... .. SAN JOAQUIN LOCAL HEALTH DISTRICT l•• ._ _.� _ _ --� 7/72 3-M