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FOR`OFFICE USE: r_ _ ✓ APPLICA'T'ION FOR SANITATION PERMIT :.t.. (Complete in.TriplicateL. __..� _ Permit No. .7 :.....�.. .. .......................................................... This PermitExptres 1 Year From Date Issued Date Issued .,� X5.7 T Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549.ond existing Rules and Regulations: .TOB ADDRESSAOCATIO .......... Owner's Name ._.�.. ----.�+--�--7.�..� � �_ ... CT •----•--•-•-----••-------- ' ------••-- •, .... Rhone Address -•-- City .-A A Contractor's Name, a - / i 1 =rtment --• #`.......License _. d_,i _ PhoneInstallation will serve: Residence 1=fousefl Commercial❑Troller Couit ri I Motel ❑Other....----..: .................................. Number of living units:.._. Number of,bedrooms .:Z.,-,.__Garboge Grinder .............Lot Size C.ZWater Supply: Public S stem and name u - _................................................Private Character of soil to a depth of 3 feet: Sand%. Silt 0 Clay ❑ Peat❑ Sandy Loam 0-, Clay Loam ❑ Hardpan 0 Adobe 0 Fill Material ....... ..1f 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 tank or seepage pit ,permitted if public sewer is available within 240 feet,) PACKAGE TREATMENT I ] SEPTIC TANK i ] Size......... - B 1_ -p-------------------------- Liquid Depth ---- CapocityJ/ZC0.---- Type .. Material.._L�xt�►�►..--- No. Compartments -,-2--w � Distance to nearest: Well '' ' Z ......................::.Foundation �O___- Prop. Line __/:0 LEACHING LINE [ I No. of Lines .---��•-<___-------••-- Length of each line.....:. . ------..... Tata! length ...f---y_o �1 Box �" �� ---........ ----- Type Filter .Material _.�..... .t'+ �.Depth Filter Malarial ....`� '`.Zr......-............... Distance to nearest:•WeII ._.- ............... Foundation '....1. ........... Property Line ............ f SEEPAGE PIT p Diameter Number ............................_ { . 'Depth -------------------• Rock filled Yes ❑ No Q `. Water Table Depth .................... -:-......•-Rock Size 'Distance to nearest: Well -^ - `. .. ::.Founds#ion ---•- ••. ...................... Prop. Line �f ` REPAIR/ADDITION Prev. Sanitation Permit# ... Data Septic Tank (Specify Requirements) ...:......... .. rs _._._,........................... ' ...----•----•-----••..............•-- ................... Disposal Field (Specify Requirements) ....... ' ...................a.._____-...j..._...._.......__.- --------- ------------------------------_----------- - --------.................•............... ..__.-_..-.......[_...rw..._.._....._........................................................... -------------------------------------------------------- (Draw existing and required addition on ieverse s€de) 1 hereby certify that 1 have prepared this application and that the work wIII be done in accordance with San Joaquin 4 County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health:District. Horne owner or licen. sect agents signature certifies the following- Ad] certify that in the performance of the work for which this permit is Is�ad, I shall net employ any person In such manner as to become subject to Workman's Compensation laws of California." Signed � � - -'` _ Owner -- -- ---- ......•--•••••:-- -- . By Title ----- ( .of r th n owner) ------ . ....................... R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY._------------- -------------- BUILDING PERMIT 15Sf1ED . ................................. ' _ ADDITIONAL COMMENTS i --75- 5 -DATE .- ---------------------------------- ATE ._ ........................... --------•------- ..-._- • ----------- -----•--••------....-•--- ----•------------------- ...--- •------••-•• '- --------..._ .....-.-._.- - -------------------••------••��•...._....__ ._. --------- fins! Ins action b ------------ _ p y: ....._,. Date/--Z-- ' lit 13 2h 1-68 5m ------- ---'-----• - . .... SAN IOAQUI OCAL HEALTH DISTRICT B�7�f - M 1