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Fox c7ra usi APPLICATION FOR SANITATION FEW Permit No. .1--•�"�=�� (Complete in Triplicate) Dote Issued This Permit Expires 1 Yeor From Date Issued i H-aith District for a permit to construct and Install the work herein Application is hereby rradr to the San Joaquin Loco Or described. This application is mode in compliance with County din/once No. 549 and existing Rules and Regulations= ' ' _�i'.J./.. CENSUS TRACT ............... .......... JOB ADDRESS!IOCATION // /. + 1 .-../Y......��• Phone ............................... 1..�iC............ .......... .... ................................ Owner's Namc / - i� ,�....................................... ... . ......... ...... Address !, � ; . .. .......... ty / �... /�iJ l License#/. ,-/-/./.. Phone .(- Contractor's Name A,: 1 . / .0 .t.'./.�-_.t.'.... ........... t Installation will serve: Residence(g Apartment House C] Commercial❑Trailer Court D F Motel C]Other .... .... ......................... i �/,(I.. lot Size . ..4G:fr.. ................. Number of living units: _L Number of bedrooms ......Garbage Grinder . S Water Supply: Public System and name .......................................................-.Y...................................................Private Character of soil to a depth of 3 feet: Sand C] Silt❑ Clay ❑ Peat❑ Sandy loam❑ Clay loam[I .. Hardpan❑ Adobe� Fill Material ............If yes,type....................... ... (Plot plan, showing size of lot, location of system In relation to wells, buildings, etc mutt be plead on revere side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) Q PACKAGE TREATMENT [ I SEPTIC TANK[ Size.............................................. . Liquid Depth .......................... Material...................... No. Compartments ................. .... Capacity . Type .................... .Foundation...................... Prop.line...................... z Distance to nearest: Well -•••-•-•••-•-••••--•••• Length of each line........................ Total Length LEACHING LINE [ ] No. of Lines .. _ ..... - 9 �•- — .De Depth Filter Material ............................................ .4 1'1� 'D' Box ............ Type Filter Material .................. p , � Distance to nearest: Well ........................ Foundation Property line ........................ SEEPAGE PIT [ ) Depth . . Diameter ................ Number ...................... Rock Filled Yes C] No (] } j Water Table Depth ........................ ..................._...Rock Size ............................... ( ... Prop. Line ..................... Distance to nearest: Well ................. . ..............Foundation ............. .. REPAIR/ADDITION(Prey. Sanitation Permit# ........ ...... ....... Date ..................................) .. .............................. __ ._................ Septic Tank (Specify Requirements) .... .............._..-4 � - �• � Disposal Field (Specify Requirements) -.-.--Ll( ••( ••-••••/... "" ....--•-•---••-••-•---•..............................•-•.......... ; _ . . ... ........I..............-.............._............................ (Draw existing and required addition on reverse side) 1 hereby certify that I have prepbe done to accordance with Son Joaquin ared this application and that the work will and Rules and Regulations of tho San Joaquin Local Health District.Herne Owner or "con' County Ordinances, State Laws, sed agents signature certifies the following: in such manner r .4 certify that in the performance of the work for which this permit is issued, 1 shall not employ arty F1eport N as to become subject to Workman's Compensation laws of CaIlfOmia." Owner Sig 'i �ned .- ... . •-.'..r:------------------------------------- Title ...,f-tT,,.r,�L1��.......................................----- ..<. ...1.�. z. By (if othey4han owner) MR DEPARTMt:NT USE ONLY �• DATE .. APPLICATION ACCEPTED BY _..! ... .. DATE ........................................... ,t BUILDING PERMIT ISSUED ................................................. ....................... .................... ............... ....I................................ ........--•---------... ADDITIONALCOMMENTS ................ ..... .. ......... ........................................................... .............. ... .......... . ........... .. ..... .......................... ........Date .... :..••••••••:r ..- .. . ... ........................................ ` Final Inspection by: SAN JOAQUIN LOCAL HEALTH DISTRICT , r u 0 1•'68 Rev. 5M