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tt;+ FOR OFFICE USE: ': APPLICATION FOR SANITATION PERMIT i" Permit No. .��.�. ��. .4: (Complete in Triplicate) .......................................................... Date Issued (, ..........:.:.........:...........:........ This Permit Expires i Year From Dafr Issued Application is hereby made to the San Joaquiri local Health District fora permit to construct and Install the work herein. described. This.application is made in compliance with County Ordinance No. 549 and existing Rules and Regulationst •� ;.'. r a' JOB ADDRESS/LOCATION .. .��.Sv �...... ..... .. ... . ...... .... ......... CENSUS TRACT .......................... aY Y; Owner's Name - n Phone Address . ... y �5 Q. ....�: ... /�............ City ... .... Contractor's Name .:..Ca1t!lutar..• -.. �••- -• ....License # . Phone . ttt Installation will serve: Residence [iJ Apartment House❑ Commercial ❑Trailer Court Motel ❑Other ............. NumbAr of living units:........I.. Number of bedrooms ...c.,5....Garbage Grinder ..... ...... Lot Size ..... 9 Private Water Supply: Public System and name ........... . . . .......... Sand Loom ❑ Clay Loam Character of soil to a depth of 3 feet: Sand❑ Silt Q Clay ❑ Peat❑ y {� Hardpan E] Adobe ❑ Fill Material ...... ..... If yes,type......... . . . f (Plot plop, showing size of lot, location of system in relation to wells, buildings, etc. must be plared'on reverse side.) a ` t 1 NEW INSTALLATION: (No septic tank or seepage p;t permitted if public sewer is available within l00 feet,) 4 Size.... : Liquid Depth ............ PACKAGE TREATMENT ( ] SEPTIC TANK ] •• "' ` {, t Capacit .....- Type .................... Material............. .. ..... No Compartments ........ r ............Foundation ................. . Prop. Line ........ Distance to nearest: Well ....................... No. of Lines length of each line ......... . . ............. 7oloi Length „- LEACHING LINE ( j •• .. 1 4, D' Box ............ Type Filter Material ...... . . . . . .Depth Filter Material ........... .. ... +. t Foundation Property Line . t , r Distance to nearest: Well ........................ --•-•• �•••••• i 1Diameter Nun:e. .................. Rock Filled Yes [3SEEPAGE PIT O Depth 0 r Rock Size ............. Water Table Dep1h a.h , Foundation ............... Prop. Line ........ Distance to nearest: Wel ....................................... _. .......`.: .. REPAIR/ADDITION(Prev. Sanitation Permit# ........ . ....... ......................... Date ........ 1 Se tic Tank (Specify Requirements) . ......... ....... ....:......... ............. ..........................................._ ` Disposal Field (Specify Requirements) fid. ...... .................. $t ry r • ' yTa G....................... ..... .. . _. .. .. ...... ..... ............. ................. ....... ................. .. .......... ... . 'F� ? (Draw existing and required addition on reverse side) application and that the work will be done In accordance with San Joaquin ;E' y I hereby certify that I have prepared this app County Ordinances, State Laws, and Rules and Regulations of the San Joequin Local Health District. Homo owner or Iicer►- r .. sed agents signature certifies the following: 1 shall not employ any p erst. ;n such manner "1 certify that in the performance of the work for which thN permit Is issued, as to become subject to Workman's Compensation laws of California." { owner signed ... H in 1 a �.. ...... .. .. i� ..CJ. .... ... .. ..... ........... Title e .�ti. t �u f"�'4 -. .. ... 7 (If other than owner) ' FOR DEPARTMENT USE ONLY l -•� ... ............... .......... . DATE .S'��.........._................. r .................... APP!JCATION ACCEPTED BY . r_,t.[_.... ........... ... . DATE ._........................................ .:, i BUILDING PERMIT ISSUED ......................................................... . _........................................_.. ADDITIONAL COMMENTS ... ...............�............................................................- ' ................... ............. ................................................... I. ...................................................................................Date ..:.��. �...�.. Final Inspection by '. " SAN JOAQUIN LOCAL HEALTH DISTRICT E.H. 9 1-'68 Rrv. 5M f ' ,ftitin 1 t G ,,i*tb L;.ta J 3.✓,p _'C.�j F'�.N , , �. , iAGxi.�i 1 7'' ;' r t`t1 C .riT� „.r.fi .t$ 'trf'�'Y4�rw"'�i •,h, •.,.. ?#c:, ` '.�. >��t,,,,_�p�