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FOR OFFICE USE:: APPUCATIO14 FOR.;SANITATION PERMIT Permit No. ...7�~_�.�.� ............................. •--..-.- .............. (Complete in Triplicate) .................................. .• Date Issued . ..... 3 .. .--........-................ : �`'' .�,.• This Permit Expires I Year From Date Issue I; Application�i�'hereby made.to the San�Joaquin Local Health District for a permit to Construct and install the work herein descri ed. This applicatios made inf-compliance with County Ordinance Na. 549 and�e�(sting Rules and Regulations: ! 36r. . �. ,• } C TRACT .......................... JOB ADDRESS/LO A IO Phone Owner's Name ............................. ....................... .. .. ........ -.- Address City " � ...Aicense #c -7 .•--- Phone T................-� ... .........Contractor's Name ... G .?. '..------ r Installation will serve: Residence � artment Flouse'f"] Gorramercial ❑Trailer Court i;. Motel ❑Other •...................i- :.. Number of living units:- ..-..�.. Number of bedrooms �__---Garbage Grinder--- Lot Size .....................::........... .. -••- Private ❑ Water Supply: Public System and name ..........--..................................................................... .... Peat -. Sand Loam fl�IayTLoam-0.;, Character of.-soil to_a_depth of.3�eet:� and_ „Silt_-�. • „.'--Clay ❑_„•. Yx. .-rte e -------= .....-. Hardpan ❑ Adobe Fill Mater-�F If yes,type p . l d 1.l€r (Plot plan, showing size of lot, location of system".in--relption to wells, buildings, etc. must be placeon reverse side.) .f r r • ewer is available.within 200 feet,) NEW INSTALLATION: ( p `' F' p 9 P E3 a � _�, No septic tank or see a e it permitted E public �rLiquid Depth _..��"••-••••-•- PACKAGE TREATMENT, j SEPTIC TANK i •- ;-...' .. :.... • 2 ® M'aterial - -:-KNo. Compartments . • Capacity .. ................. TYp « Prb (stance to nearest: Well ...} ,_- ouridation:.. 10&7i p.ii ine �. --..:-•--•••--- j.._r. .... '. . - �. a � �- .. Len th of each•line._-_- !Total Length LEACHING LINE [:�) No: of Lines -..-:..' ' 9 . :..i '?.De -Depth Filter Material' ..............•-•-.•---•i•--• ---- -- �. 'D' Box Type Filter Material ._1 ..-,--••- p a . . Distance to nearest. Well •,1.;. r Foundation . ./_�_.-...-•--_,.•' Property Line _.fr`. f' IT Depth -_, S___-.._. Diamete' Number .-._ .........._-`--.-:..-_- Rock Filled Yes �No ❑ I` � SEEPAGE P [� "- -•- -- Water Table Depth ..__--...Rock Size .. Distance to nearest: Well ................ Foundation .1.� �-_.-_... Prop. Line j-•••-•-•...... i Date " REPAIR/ADDITION(Prev. Sanitation Permit�# •.••••----•••••------••--- Septic Tank (Specify Requirements) ------------------- --------•----••--•----- -------------------------------- ' • -- Disposal Field (Specify Requirements) _-__•_-...--••--- ........ •--••••--•••• ............ ............................................... -•---- ••----- _ -.^ =,v— .. �._r ..-....-_ h San ,too uin i (Draw existing and required addition on reverse side) I hereby certify that I have. prepared this application and that the work will be done inr accordance wit Q Laws, and Rules and Regulations of the San Joaquin Local Health DistrlctL(Home owner or lisatt- County Ordinances, State La b ' sed agents signature certifies the following: ' "I certify that in the performance of the work for which this permit is issued, t shalt not employ airy,person in such manner as to become sub)ect so Workman's Compensation laws of California.". --- Owner ` Signed ..... By --------- --..... ... .. J •-•---••------ Title i (If ther t an owner) I FOR DEPARTMENT USE ONLY f k DATE _.... jZ,3 ? ..._...... , APPLICATION ACCEPTED M1 ...___ ••- DATE l BUILDING PERMIT ISSUED ADDITIONALCOMMENTS ... ................................................•---- ---..._•----:..... - ... - .._...... - .......... ---••---•----•---••----- ------- -•----- .................... tt ..............-- -...._-...-. - Date . ....L I - Final Inspection b -- -� •--•---• --••- .............. Date - ` SAN JOAQUIN' LOCAL HEALTH DISTRICT 7/72 3 M r 13 24 a., SAA -