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L M ON FOR SANITATION FIRM 7. Z R OFFICE USE: - � Permit No: - '�" 1Complew in Triplicate) Date Issv6d .9" = 7� .... _ ................. This,Perhnitlxf+ites 1 Year from Data Issue N m !lance with County Ordinance No. 549 and existing Rules and Regulations= Application is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work ren ' ' desuibed. This application is made in co p TION ...__. /(i�6rJ CENSUS TRACT ...................•...... �r �t sr/A2f---•--- k ! JOS ADDRF.55/LC+CP+ •�•• - � i....•----•-----••-•_---.Phone t �. �.T.�- _.__._ - �. ........ _. Owner's Name ._ lJr �r /v....... G' Address _-. 69W 0.7.- _• ..............-.------------..:.---------•----- :._.. Lica 1 1 - Phone i .. ...- r -1�-A* i Contractor's Name ., martial❑Trailer Cah�ihtr❑ ResidenoeZ Apartment Hayse❑ Installation will serve: - 1 Motel 0 other a�if�_. ?!G__•-•-•--- .e ,2 Garbage Grinder , -----••-- Number of bedrooms .. • 'd-_. Lot Size ._� _- --•�•••-_.._. r Number of living units..........__ Private$ Water Supply, Public System and name ---------------------............._ "❑j'-' Peat❑ Sandy Loam[} Clay Loam❑ Character of soil to a depth of 3 feet: Sana!:0 Silt❑ Clay Hardpan 0 Adobe jJ, I'll!Material....._...... If yes,type. ....... 1 I (Prot plan, showing size of lar, location of system in relation to-wells, buildings. etc. must be placed on reverse side.} N1rW IN5TALLATION: (No septiDepth c tank or seepage pit permitted if Public sewer i;available within 200 feet.} _ - Liquid D PACKAGE TREATMENT 13 SEPTIC TANK SiYe..J'a!s. ....... r4V. tlin, No. Compare nts ---• Type/$Capacity�� ... Materia = q r ' Distance 1a nearest: Well .__:fes...........-•-•• i=aundation Prop. nes- ='..:-:-•--•. f _Length of each Zine.. -`----•---•------- Total Length .ILl.C�.-'�---_------.- LEACHING LINE Do No. of Lines ...-__-/----------•---_Ian �� .. 1 � -.---DeI� Filter Material jff. .. D� ga Type :Filter Material . _--••- { Distance to nearest: Well ------� ---. Foundation .._14................. Properfiy Line _.. �........--.-. _ Rock Filled Yea- No;] Diameter .� -------- Number --• ., ' SEEPAGE PIT Depth _. t3' � , _ /z............•. Water Table Depth -----iOlPQ-------••-..-.-..---•---- Rock Size O r Distance to nearest:Well ..... ............... Foundation ..� Prop. tine ..vim................. REiPAIR/ADDITION{Prev. Sanitation Permit ------------------.•.........._••...Y-. ............. Date ------••----} � (Specify Requirements! ------------------------- I ---...... ._... •-- —............. Septic Tank -•---•-----...-•----- . t --• --------• ------•--••.........-••--•.... Disposal Feld ISPecifY Re uirements} ---......---•------------••----••-------•------- ................ • • _ -----•----•-----------------------------•--• -•--------=--- --------------------------- :......._------------..........-----------------•-.••-•-- t pawexistingand required addition on.reverse si e I hereby certify that i have prepared this application and that the work will be done in accordance with San Joaquin gulations of the San Joaquin Local health Dishict: ea Home owner or lice"- County Ordinances, State Daws, and Rules and Its # sod agents signature certifies the followings P arson in such manner "i certify that in the performance of the work for which this arniit is issued.! shall net eenpioy any p as to become subje7t *Tk 'a ' Compensation laws of CaliForrhia."Signed ................. ... .Owner ... .. ----•-•-•.........-- I er th o ver) , • Kali DEPARTMENT USE ONLY --.._ -.- I DATE -`-� � - ••••-•--•............... APPLICATION ACCEPTED BY f-•--------------•- 1 -..................................BUILDING FDATIPERMIT ISSUED -_- ••--•--- ADDITIONAL COMMENTS h ....................-... _... _=_ .................. ........-------•--..... .....�. ........Date .-- _ Pinel Inspection bye...................... ................. K} SAN Tit IN LOCAL HEALTH DISTRICT 1-'68 Rev. 'JM