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FORy.� E USE: APPLICATION FOR SANITATION PERMIT Permit No. .z .................................._..... i (Complete in Triplicate) Date issued �. � --------------••---.-... This Permit Expires 1 Year From Date Issued e to the San Joaquin Local Health District for a permit to constr�and existi g Rulesand tatndhReg lotions.'e'n Application is hereby mad . , described. This application is made in compliance with County Ordinance No. 549 a --' /;ft..c:CENSUS TRACT JOB ADDRESSACICATION.,• Phone ..... Owner's Name -..----j.C2 A--w--.-- rc,n/..O.1 r....... ............. a ..... .. ....-............................ ........... ..-.._. City .7%�OVwy AddressPh --- - _ • -•---..License #4` ........................ one Contractor's Name ........ A Residence pertrnent.Houses] Commercial-d—Troller Court 0 _ Installation will serve: �• , _- ;1- t Motel ❑Other ••-- ---------- --•- �, - �. Garbage Grinder :.........._ Lot Size .._.. _ ............... ❑ Number of living units:..-------- Number of bedrooms . -- ---- f ..... _ , r va a Water Supply: Public System and name ._....................................................... .. Cloy peat.-❑'Sandy Loam. Clay Loam ❑ 0 Character of soli to a depth of 3 feet: Sand�] Silt y ❑ - Hardpan Adobe-❑ Fill Material .. tf yes,type ............... .....' :... f i4 r _ Y `buildings, etc. must be placed on-reverse aide.l (Plot plan, showing size of lot, location of system in relation to weEis,{ t -� - ermined if public sewer is aZilaable withib"200 feet,) J NEW INSTALLATION: (No septic.tonk or seeps pit :p f r t i — Size..._.....:_- -'•�_� ._-�Etquid Depth _. .,�. PACKAGE TREATMENT [;] SEPTICTANKje ,,, ,; r � `", . Material .. .. % `Capacity _I. C2L)__-__... Type �. �d ,� No Compartments f ` , r >� --------=�=..noun ation _.��_.:.... x'"P'op. L - ine � Distance (to nearest: Well _.1( ?-----•-• .� , r - /� �z' s ..Total I.eng�h :_ ........._. !:F.v No. of Lines -.--------. -• •-•--- Length of each line.._.._...--•.,,_... LEACHING LINE ( �� � , .De th Fil#er Material .._........•�. . :�.......---•-••--••-•-....� T. a Filter Material---•�•-• P ,• 'D'.'Box _... Ty, r f? Distance to nearest: Well _._`�Q.`,.•--...--• Foundation -. ---•--•. Property Line ......._ .._-.O L ' Yes ❑ N6-[3-. i. -Number Yom-- Rock-Filled ' 5EEPAGE_i'IT [ 1.:,,�.-.,,r bepth } Diometer�___ ==:_. hp,.�.�..—�-^— --------------------------------------- prop. Size ................................ Water Table Depth � ----Foundation .................... Prop. line _.....---•-••--....--• S► Distance to nearest: Well __.___.-- ••-••--•••- ---• - l r Date ..----•--- ) Vf REPAIVADDITION(Prev. Sanitation Permit# -.--_-__._---------------•------ ; ' --•---- -•- -................I...... - Septic Tank (Specify Requirements( ------------------•----••-- --• Disposal, Field (Specify Regvirements) .- •--- --•--•--•- -•--- ---- •------- :_ -- -- ------•--------------•-------• ------...-- ------•------ ---.._..---------------- ------ -. ........... --- ---------- ---- -- •- - - - -- -------.----- •---- - --- --- ----•- ---- -• ---- .... ------------------------•-------•--------------- .....:... (Draw existing and required addition on reverse sl del / plication and that the work will be done 11 in accordance with Sart Joaquin I hereby certify that I have prepared this app r County Ordinances, State Lav+rs',!and Rules and Regulations of the San Joaquin Local Health,811strict. Home owner or licen- sed agents signature certifies the following: `` .. "! certify that in the performance of the work for which this permit is-issued, ! shall not employ any person in such manner as to becom stib'ect to Workman's Compensation laws of California." Signed - L��/� .t�& =: m= _ Ow ------- --- ------ -------- Title ---------- - - --------------- �------ ------- By lif other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _.-.- ---- - ....:.. . ..... . DATE -�_.`� 1 ...._ ---- -: _.-. ��---- ----•...........................DATE -._. -------------------------------------- BUILDING PERMIT ISSUED ------------ -•---- ---------••----- •----••••----- •------ •. ADDITIONAL COMMENTS - -----------•---•--- --••------------•---•-----------------•- ------ ... ....---••- .....•.. --._... .......... .... :;'' . ..... ........ r ---•----•.................••- _ - Date final Inspection b EH 13 24 1-69 dbay. I SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M