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FOR OFFICE USE: APPLICATION FOR SANITATION PERM ' Permit No. . ........... ...... .7.1.-..��..L .: • (Complete in Triplicate) ................... _...... Date Issued ... . .. This Permit Expires 1 Year From Date Issued Application is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work herein described. This upplicotion is made in compliance with County Ordinance No. 549 and existing Rules and Regulations, QQ CENSUS TRACT ......................... JOB ADDRESSAOCATIONJ�./..� 4... ".... . J t ru.. ..........Phone ...........................• ... ; Owner's Name !�'� .. .. ... . .... .. .. .. :.. .... . ...... .... Address 57. <' � .....�2—..... -- -._.._v....City e!5 .................................................... �y� ...Jae.license# -(.Y._ »...--------»...... Contractor's Nome ��-- "" ' Installation will serve: Residence❑Apartment House 4-' C Mercial ❑Trailer Court ❑ " i / Motel ❑Other .... .. ........� Q,..... ........... i Number of living units: _.L...... Number of bedrooms ... Garbage Grinder ...._....... lot Size ...._ ` _ .........................••--.........................._......Private Water Supply: Public System and name ..................................__........ Character of soil to a depth of 3 feet: Sand 13 Silt❑ Clay Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan❑ Adobe ❑ Fill Material ............If yes,type............................ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc must be placed on reverse side•) NEW INSTALLATION: (No septic to or seepage pit permitted if Public s�wer is available within 200 feet,) I / v PACKAGE TREATMENT [ I SEPTIC TANK Size---flrvG`-,.. ..••r �!-.......... Liquid Depth ••••• �d'j Q a Material.-if)t .. ... No. Compartments .. .......... Capacity Typed ... / / ........Foundation .-./..LI......-... .. Prop. Line....._......».».._. Distance to ne rest: Udell ......... A•-•-•• �/ �..Q.o..------- LEACHING LINE [►7 No. of lines ._ .....�__...... .. Length of each line...../.G.4...... ••---• Total Length��.. i 'D' Box Type Filter Material .S-r.R:...•-Depth Filter Material ...-.�.g•...--•-••••-••-» 1 /.Q.�.......... Property line ...,t`..............» Distance to nearest: Well .......r' .C.�...-••••� Foundation �.:.... Number ........�........... ...; Rod- Filled Yes No Depth ....1®-.........-Qw w -•-- ... ................... oc ..L.�d.....x..., '., . Water Table Depth Rock Size ..... r line ..`r._.. Distance to nearest: Well .........J40 •-•- Foundation .....I..Q.._...... Prop. ` ) �+ REPAIR/ADDITION(Prev. Sanitation Permit 4s ............................................ Date .......—------------»---» ` _..-_-------..-------- ..........�......._...».. Septic Tank (Specify Requirements) ......•-•••...................' i Disposal Field (Specify Requirements) "--.-•-•••--•-•••••••••••••-•••~---•••••-""»"" ................. i ................................................................. .... ........ ............. ......._......................._....._..................»...� .............................................................. . .. . ..... .... (Draw existing and required addition on reverse side) will be I hereby certify that I have prepared this application�ndffhof�:WinJoaquin 4 in Lecalone In accordance with San Health District. Home ewner w pterse County Ordinances, State :aws, and Rules and Regu sed agents signature certifies the following: "I certify that In the performance of the work for which this pli ►nlo issued, 1 shelf not employ any person in svcls�a�K os ro become subject to Workmen's Compensation laws J Owner Signed ................ ..�..... t `Title ......... . ....._.. ............................... .............. l .. ... y • -•� � (If other than owner l FOR DEPARTMENT USE ONLY ................. ............................................................................... DATE .... ...........•--- APPLICATION ACCEPTED B.. . .. ...... .....DATE ....................................... ADDITIONAL COMMENTS _.. BUILDING PERMIT ISSUED .............................................................................................................................................................. ............................................ . ... ...................... .......:....::........... .... . :.........;:....... ......; »....... ... .. ....;.• . ....:�c .......................... ... .....................................Date .. Final Inspection by: SAN JOAQUIN LOCAL HEALTH DISTRICT i� E. H. 9 1•'68 Rev. 5M