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1� FOR,OFFICE USE: �`y APPLICATION FOR SANITATION PERMIT --- --- ,- -- ------- - Permit No. ,. A (Complete in Triplicate) --------------------------------------------------------- This Permit Expires 1 Year From Date Issued Date Issued__- _ __ g Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This ap lication is made l�iScompliance vXith County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LCATION ----_.__ -------- ----------- lig''SAM P-694L----- -- --CENSUS TRACT -- -------------------- Owner's Name --------- Pti--------RQgj=_=P,-j- at\J---------------- -------------------- ------Phone Address ---- ------PY4 40 LLQ_ t 7------------------------ _ ----• ---- City --- - -- --------- Contractor's Name ---- - ---------------------------------------------------License # ----- ------------------ Phone -------------•-------•-------- Installation will serve: Residence partment House[] Commercial :❑Trailer Court ',❑ Motel ❑- Other ----------------------- '------------------ �! Number of living units:-. --1- Number of bedrooms�i,�------Garbage Grinder -A10_- Lot Size _.7Qp--� 2!��''+z _:.... Water Supply. Public System and name ------------------------------------------------------------------- --------------------------------------------Private pp Y� Y Character'of soil to a depth of 3 feet: Sand❑.: SiltjID_.. Clay ❑ Peat$0- Sandy Loam '❑ Clay Loam 8� —Hardpan ®�Aclobe'❑ Fill Material - If yes,-type -------- (Pl'ot 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 seepacle pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ SEPTICTANK! `- Size---- —----------------------------- L.icluid Depth ---�---�,...�.----- 'Capacity 1a0.©--.--- Type PIZE-FAB--- Material_CAIC------ No. Compartments ---- ._._...... �f r , Distance to nearest'Well ------`fi-----------------FoLMdation _/0----------------Prop. Line LEACHING LINE [.r"' No. of Lines ---_ - -2-L Length of each line___ =`_______________ Total Length ,_00-`__---_-_--_-__ D' Box -yType Filter Material --___Depth Filter Material ___1 ``----- ----------- - f Distance'to nearest: Well 1_____ Foundation,'_.. _ ''_ _P..r tine ------------------- -------- _____________ _ _-- SEEPAGE PIT [ Depth /��------- Diameter f x I�lutnlaer - - Rook feiir lfes [►}�iMo.� {y ---------- { ------------------- � Depth --:---��_ - - rC- --- QOC�C .�1= f Water Table >De _ Distance to nearest: Well ----1 __,-_----___---_-__•�-_-•--Foundation�.1 _._'tt-_.rap. um .. __._�' fj ftPAIlR/AODITI MSPrev:Sanitation Permit-# k flats __; --------------t---------------I v� Septic Tank (Specify Requirements)(--- - -.- r ' === = �r _ =ii` "' - `--- :- ------------------------------------------ Disposal Field (Specify Requirements) ----------------------- -- ---- + ---------- ------ - ----- -------------------------------- ` - --------------------------- ----- -- --------------------------_------------------------------------------------------- ------------------ t . red on,on se I hereby certify that 1 have re ares) th s n jil tcWon,and (that the work will rbe d�+e in acc6irdanee with Son Joaquin-- -- �� Y Y T P- p__._I pP ` County Ordinances, State L"S', and'Rules Regulcl i4ns,of the. Son:Joaquin Local Health Distr�yt. Home owner or licen- sed agents signatjFi-certifiesthe following: r l ` _ I, "I certify that in the performance of the work for which this permit is•issued, I shall not employ any person in such manner as to become subieo Wo man's C laws of California. t Signed ----- - - Owner BY ------------------------------------------------------. ---- T.itle -------- - `'' -------------------------------- (If other than owner) FOR DEPARTMENT USF ONLY 1 APPLICA-VON-ACCEPTED-BY [ - -- -_ - ---. -- DATE -== , BUILDING'--PERMIT- ISSUED _ _ .'_j am'+ �Y ' Y `fi3ti w' ` -s- '- DATE -- ---- ' _._ �v ,.� �'�=_��----- - -- ---_'�� _ - •-- ------------- --- ----------- ADDITlONAC C07V1NlENTS': - . --------'--- - -- - --- 1 L J! vr` __.'--------_____________________ ___ __ _____ _ ____ -------- ------------------------------ _ --- __ - _ Final ection b . -- Date 3 SAN JOAQUIN LOCAL HEALTH DISTRICT i E. H. 9 1-'68 Rev. 5Iy I