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FOR OFFICE USE: APPLICATION FOR, SANITATION PERMIT Permit No. -------------- (Complete in Triplicate) ----------------------:-- Date Issued - ---- ----------- :-- ----------'- This Permit Expires 1 Year From Date Issued ------- . rict for a it to construct and l the work rein Application is herebymade to the Son Joaquin in tical Health DytOrdinan a Nom549 and existing Rules tand Regulations. described. This application ism in comp 9'_,3e -- -- --- CENSUS TRACT -------- 6------------ JOB ADDRESS/LOCATI N ----- - e �J ,Q _.Phon -�-- - �/C- ------- —V 6. C Y ---------------- - Owner's Name _."-- - - ` � = [1/ "_ `< '" City �- Address -"--.-/ • 70 License # I Q Phoneg.,�.3 - Contractor's Ar Name __ -- ----- Installation will serve: Residence partment House ❑ Commercial ❑Trailer Court '❑ Motel ❑Other ------$------------------------------------ __ ---"Garbage Grinder��---- Lot Size "--"---� - ��---•""' • 1 Number of living units:.---/-- Number of bedrooms -Private @/ ---------- ------ Water Supply: Public System an name ._------------------- a Sandy Loam -E1ClY Loam� ❑ Character of soil to a depth of 3 feet: Sand'e Silt F] Clay ❑ Peat❑ Hardpan ❑ Adobe.❑ Fill Material -.-A'LQ If yes,type ---- (plot showing size of lot, location of system in relation to wells, buildings, etc. must be placed' on reverse side.) [Plot p ,) (� NEW INSTALLATION: r. lNo septic tank or seepage pit permitted if public sewer is available within 200 [ ] DTIC TANK�[ ] Size------------------------ ----------------------- Liquid Depth -------------------------- � PACKAGE TREATMENT -- Material---------------------- No. Compartments ----------------••--- SIZ Capacit -- Type ------------- a,, Distance jto nearest: Well ------------------------------------ I ---- - --------------------------- Foundation ---------------- Prop. Line ---------- = =.: W LEACHING LINE [ ] No. of Lines _---------------------- Length of each line--------=-=---------- ------ Total Length -" 'D' Box ----- --- -- Type Filter Material --------------------Depth Filter Material -""----------"------ ------ --•----------""- I Property Line ------------------•--•-- ---_--- Foundation ---- Distance#o nearest: Well ---"----------- No i[] SEEPAGE PIT [ ] Depth ---------------- Diameter ---------------- Number ---------------------------- Rock Filled Yes E] Rock Size - ------ ----- ----�--- Water Table Depth -------------------------- ------• - Distance!to nearest: Well "-----"-------------------------- --•---Foundation - Prop. Line ----------•---•------- jDate ---------- ----------------- ) ` REPAIR,/ADDITION(Prev. San�tatio n ermi ------------.---- --- -- Septic Tank (Specify Requirements) -.---------- --- ---- -- �-•C�•G W —_- /Disp sal Field (Specify Requirements) "-- -------------------------------------------- - ----- i - ""- (Draw existing and required addition on reverse s ne in I hereby certify that I have prepared this application andthat the work will be the San Joaquin Local. D strct nce Flameltownar or licen- County Ordinances, State Laws, and Rules and Regulations sed agents signature certifies the following: erson in such manner "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any p ' as to bec me object to Work ns nsation laws of California." - ----- ------------------ Title (I o4er anowner) FOR DEPARTMENT USE ONLY DATE ---5=-------------- ----------- BUILDING ACCEPTED BY -.7-1-9,0, ---------- -- ----------------------------------- - ---------------------- DATE BUILDING PERMIT 155EJED ----- -`------------ ------- ------ - ----- ------ -------- ADDITIONAL COMMENTS ------ ------- - ---------------------•------------------- ---------------- -- -- -- ---- --- ---------------------- ---------------------- ----------- --- -- �- ---------- -- - -------------------------------------------- ---- --------------------------Date -- ----------- f- ---- -------------- ------------------------ --- Final Inspecti SAN JOAQ6N LOCAL WHEALTH DISTRICT E. H. 9 1-'68 Rev. 5M