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a �, LICATION FOR SANITATION PERAIT permit No.. =w, L__ FICE.l1SE: � `� ----- "�^ (complete in Triplicate)- Date Issued `-3-"-- - ----------- ThisPermit Ex ires 1 Year From Date issuedp- ermit to construct and 'install the work herein . Ordinance No. it t and existing Rules and Regulations. ealth Application is hereby made to the San Joaqulilance witlh Cou pytrict fora p lication is made in comp • This app ' yy^� CENSUS TRACT -------------------------- described. ;2�� -�f-� ---- - - _Phone SOB ADDRESS/LOCATION f ---------- c - - r`'� ------ - City Owner's Name --- �` ------- -- - _ .W_ - _).7- Phone ..-�-�-�----��- - - Address 75 = License # - -5-�..- Contractor's Name ---Gt17 - C rrimercial ❑Trailer Court l❑ Residence E`Apartment House'❑ Installation will serve: Motel ❑ Other - O Lot Size -��--�--- - �--- - . // �__--Garbage Grinder ------------ private ) r Number of living units:----/------ Number of.Fbedrooms --- -----------------------------_-----•----- Water Supply. Public System and,name ------ -- -� Clay � peat❑ Sandy Loam .❑ Clay Loam.0 depth of 3 feet: Sand'❑ , Silt ] Character of soil to a dap Fill Material ------------ If yes, type ----' Hardpan ❑ � Adobe ❑ laced on reverse side.) etc. must be p � (plot plan, showing size of lot, location of system in relation to wells, bui{dings, c ' it perm if public sewer is avails le within 200 feet,) ` Liquid Depth ------ ' NEW INSTALLATION: (No septic tank or seepage P P Size_--------J-2 a-- SEPTIC TANK'[(]' Cl N Compartments S ------------- PACKAGE f PACKAGE TREATMENT [ 7 Material-_ {' Capacity _�.�c? 7YPe ----.-- `` Prop. Lin e>257 Foundation --6 --- Distance to nearest: We + ll �� ------,- __-- Total Length r No, of,Lines ------3 ---_------- Length of each line---- -- I ��r--------------------- f LEACHING LINE [ l 612, __Depth Filter Material --- 'D' T Filter Material p' Box -- ----- YP Property Line. �O --------- Foundation -- _0--------- ---- Distance to nearesfi: Well___ ----- Rock Filled Yes ❑ No n Diameter ---------------- Number -------------- ---------- I SEEPAGE PIT [ ) Depth I i Water Table Depth -------------------------------------- Rock Size -----Foundation --- ---- ---- ------ Prop. Line -------- ------------- , k Distance to nearest: Well ---------------------- - --------- -) Date --------------------------------- REPAIR/ADDITION(Prev. Sanitation Perms _ _______________ --- Septic Tank (Specify Requirements) ------- Disposal Field (Specify Requirements) ---- -------------- --------- ------------ - -------------•-------------------------- -------------------- -------------------------------------------------- --- __ ------------------------ -----------uire-- t (Draw existing and required addition on reverse side) I have prepared this application and that the worooaquin Local Health District.k will be done in danHometowner or liken- F I hereby certify that County Ordinances, State Laws, and Rules and Regulations of the San q P arson work for which in such manner ` sed agents signature certifies the following: h this permit is issued, I shall not em ploy any p f I certify that in the performance of the compensation laws of California." f as to become subject to Workman's Comp Owner - ---------------------------------------- --------- 5igned ` -------------------- Title _ 7r(if other than owner) + FOR DEPARTMENT USE ONLY DATE - APPLICATION ACCEPTED El -A ---------------------------- DATE -BUILDING PERMIT ISSUED -------------- ----------------- -------- ---- ---- - ADDl710 AL COMMENTS -_ --- ----------------------- a "�1i�-_ ---------------------------------- ----------- ------ ----- ---- - -- -- ate ----- --- - -- --- ----------------------------- -- -- ------ ----------------------------------- ----------------- - -- ---------------------- - Final Inspection by: ---- -- S N .JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M