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FQR OFFICE USE; APPLICATION FOR SANITATION;PIE Permit No. ................ ... licate] "r �.. _..._�..._. (Complete In Trip ..� . 7 Date Issued �. + ...................................-_...- fires t Year from Date Issued .._...... . ,.. This Penult Exp herein _.:....._.......... . _.. errrtiit #o construct and install the work Application is hereby made to the San Joaquin Local Health Distrid for` a p , e in compliance with-County ordinance-No. 549 and existing.:Rules-and Regu.ations+ pP lication is made. ... described, This app ..................... ��_ CEN5U5 - Rt:55/LOCATIO 51 ..Phone JOB ADD ......... ...... ... ... .. . _. .. _ y Owner's Name - .._....... .. 1c�-' ... City Phone - x. " �....:..:.... :.. V Address-,-:�-�-s_:.-,.�..:..� - - •- -�U-zcl� ....._. Contractor's Name --- . •. ...... .. Residence" Apartment House❑ Commercial❑Trailer:A urt . - n V Installation will serve: []Qther .................. y i Motel. ` "' .... . Y Garbage Grinder..,: lot Size . 1� r... ... Number of living units:-.. -- Number of bedrooms teg .......................... .......IVa � ..-.....:..._. Clay Loa name -Water Public System and lay ❑ Peat❑ Sa dy Loo a l It Sand silt❑� . Character of soli to a depth of 3 feet= ❑ If yes► . Adobe Fill Material ..... _ _. tYPe i Hardpan O-N- �- ` "' ""` lamed -on re arse aide. f on of system in relation to wells, buildings, ett: rriust be p t (Plot plan, showing size of lot, locati Y if public sewer.is available within 200 feet, ' No septic tonk'or seepage pit .permitted Depth NEW INSTALLATION- ( p Liquidp • Size..............:........................... .. SEPTIC TANK I ] PACKAGE TREATMENT [ ] „I partmeLts ............... i ---••- Material.................. No. Capacity •-• --- Type •-----...---• ... -Foundation Prop. Line .... .............. a � nearest: Well ............... ........ "Distance to .._.... ..... l ..... ... ..-- u ! .... Total length No. of Lines -----.._ Length of each line.--•--...._ 71-1 LEACHING LINE [ l ........ De th-FNter Material n D' Box Type.-Filter Material_,:.:•:- = P - --•__.. ._:.... Property 4.1 a ......................... ....... Foundation ................. Distance to nearest; Well --••••--• ..• Rock Filled Yes ❑ No ❑ • ._._ Diameter ............... Number ....._....--- ..:.. SEEPA��`4 ] Depth ...._..._.. a ...... .............. ...:... t � Size � _.. Water Table Depth --••--------------------------• :-. :Foundation V F ... Prop. Line ....... ......... Distance to nearest: Well. ............................. - Data REPAIR/ADDITION(Prev.-Sanitation Permit Septic Tank (Specify Requirements)....--.,.. ............. Disposal Field (Specify Requirements) .:. t.�.... ... ................... ....: a 5. . - - -------•----==------ -------.._.. - = ------------------' ---- (Draw.-exist'sng and required addition on reverse s idel uill I hereby certify that I have prepared.this application and that the work Joawuin Lotalill be aHe6lth:District--HO"ne.in ece tomer oh Son r lacen- County Ordinances, State Laws,.and Rules and Regulations of the San cl sed agents signature certifies the followings to arson In such manner "I certify that in the performance of the work for which tris permit is issued, l shall not employ an Y P as to become subject to Workman's Compensation laws of California." Owner Signed ---------X -•.4tc --- --- ----- - By .._._... -- ••-- - - ------- J'itle ..-------- - owned ` FOR DEPARTMENT USE ONLY :, DATE.. . - ..>... ----• APPLICATION ACCEPTED BY - DATE:................._.,.• . r _ BUILDING- PERMIT ISSUED ---"-r-•-------- ------- -----_ /ADDITIONAL COMMENTS -- --•------ •------ --------- -`--`••... .:.:f..._._--.....7 _._ --- - ------------- -- --- --- --- ----- ---- . -.-•--•.._Date •--•-•--......... .. /J. ? � ............... . -- ---•------- -•-••-. ---.... Final Inspection b : 8/7h 3M EH 13 .24 1-68 Rev. 51M SAN JOAQUIN LOCAL HEALTH DISTRICT