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FOR OFFICE USE. APPLICATI N FOR SANITATION PERMIT Permit_ No. ..y�S-..3J ................................................... amp e V e in Triplicate) 7 7l Date issued ... This PeExpires �'....._:.. . ' ! Permit �1 Year From Dale issued ....................... for a r.mit to construct and l the work Application is hereby made to the San JoaquinLocal itlh Health dinance No, 549 and existing Rulestaind Regulat onsTein described. This application is made in 5's�v � 1._, = ........ ................. ............... .................. 10B ADDRESS/LOCATION - Phone ...... SUS TRA Owner's Name ..:.. . r`r .�`�a .............- M.._.�. ...... . ..... .. ....`._ ._.._.........._....._.......---..._...---- Address .......�.d_ .. .. Cs• •. ...... .. �... City ... � 3 Z . Phone ......... ( � C ._.� .License # .f .... Contractor's Name . .- """' ' Installation will serve: Residence [Apartment House,❑ Commercial ❑Trailer Court Motel ❑Other ......... -----•-- ------------•--- --••-•--... Number of living units ....... Number of bedrooms .-•��___.._..Garbage Grinder .._......... LatSize .___..__°-...... ........••••-_/ Water Supply: Public System and name ..-:_•--- •••-•-•••- r ----•.•.Private [7` Silt Clay �Pegt❑ 5andy Loam [� Clay Loam ❑ Character of soil to a depth of 3 feet` Sand❑ ❑ y ❑ Hardpan ❑ Adobe ❑ Fill Material ............ If yes,type --------------------•-.----- rbuildings, etc. must be placed on reverse side.) (Plot plan, showing size of lot, location of. system—in'relation-to wells, NEW INSTALLATION: (No septic tank or see age pit permitted if public sewer is available within 200 feet,) _ , . Liquid Dept _. .. �f] PACKAGE TREATMENT [ ] SEPTIC TANK Size' r_2.. -�......R ......- i l , „�---• No. Compartments .�-•-...:.. .- �... Material.... _ ID Capacity _..��.�.-•--- TYPe . ._ ._ - Prop Line Foundation .._./,C�... ........ ....-rt-...._..._ 6 Distance to nearest: Well -••• • • I 0 y� � --.. Length of eath line. Q.d�?-••• Total Length ............................ LEACHING LINE [ No. of Lines ..-- �' ...:.Depth Filter Material ...�.}_ .............. 'D' Box .....l..._.. Type Filter.Material,...... ....--- . ^ . Nunnation 1.P Property Line ........................ e � Distance to nearest: Well �-••- •" "'-'"""'•'""_-" . Foundation f Dwmete'r oZ If /10.i ben ....----- / . Rock Filled Yes No 7 [1 Depth _...... f' r ----�^�' •--••--......Rock Size --�/.�`.._..�._ .-.... ...... Water Table Depth ___..-- ° -- t O ...Foundation -- Prop. Line .....:..........:. . Distance to nearest: Wali c`� ..... ...... REPAIR/ADDITION(Frau. Sanitation Permit�# -•-•••-•-•••• "" Date ..................................y 5 Septic Tank (Specify Requirements) .. . .... ............ ............ ................................................ ...................• ....._.....__ i Disposal Field {Specify Requirements) ............................-.....................•....... .............................................................. ._...... ........................ ..... - ..... ••---------------------••••.........._.......-----•----•-.....---- •-..... th Son Joaquin "--• ,. (Draw existing and required addition on reverse side) ne in accordance 1 hereby certify that I. have prepared this aRe ulationson and that the work will be of the San Joaquin LocaloHealth District. Ha ei owner or licen- t County Ordinances, State Laws, and Rules andnd $ sed agents signature certifies the following' arson in such manner f "i certify that in the performance of the work for which this permit is issued, 1 shall not employ any p as to become subject to Workman's Compensation laws of California." i .. . ..... .. .............. Owner Signed r ......... ....... - --- Title ... _.._._.._. : :.....:...................... (If other than owner.) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .. •............ . .. ::..:....------....---•-•--• ..............,....... DATE f •� � . 7 BUILDING PERMIT ISSUED ........................................... ..... ....••--••-.:._.....---....DAT ADDITIONAL COMMENTS .. ..................................................... ........................................_---•- .... .....__..__.... ....................................... •.._.•--•..--.........._..... ...................................................... .............. .. .............. ..... ._....__-^ •-- _.... ...... ± .rE.f? _ " _...Date �.'� � ................. Final inspection by:, f�""• .....----•---._....�........_ . SAN JOAQUIN LOCAL' HEALTH -DISTRICT _7/723 ,14 y Z 71• .... n__. CIA