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FOR OFFICE USE: APPLICATION ".,SANITATION PERMIT �. _ _ it No. - Perm' �. r.. ..�-� - _ -�----• (Complete in Triplicatel Date issued3-5—� - ---------------------- - -- ------- This Permit Expires 1 Year From Date issue Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein ibed. This a plication is made in compliance with Cou ty Ordinance No. 549 and existing Rub's and Regulations: descr py ,wry FCENSUS TRACT - JOB ADDRESS/LOC ATION , 1. -�----- _Phonel------------------------------ ' -------- ----------------- 's Name Owner f tCity __. � �! ---------------------------- ------- Address License # Phone Address ------ -----'---- -- - ��'-�---- -- ® ��^^ y !_ E Contractor's Name--------------�(97P. -- �} Installation'will serve: Residence �partment House El Comm ❑Trailer Court ,❑ Motel ❑Other - ------------------------------------------ f -- i Garbage Grinder - -- Lot Size -a ---1- � Number of living units:------ Number of bedroo�ms -"""--- ---- � _._"private ❑ Publics stem and name --- 1 __�.t�-- ,�! f '"F-------------- - 1 Water Supply: Y " Silt Clay ❑ Peat❑ Sandy Loam [I CI ay Loam O Character of soil to a depth of 3 feet: Sand,'❑ ��. — i ---- If a ---- �t ----- •, �I�� Hardpan ❑ Adobe� Fill Material _-__ -- Yes, typ "--""-f-'- ' - f - �1 �� } {Phot plan, showing, s�e of lot, location of system in relation to wells buildings available whin 200E eet� reverse side.) � C ! it ermitted if publ c sewer11 NEW INSTALLATION: ?(No r pt`c,►tank=or*se page p' p Liquid Depth f Size q p ------------. PACKAGE TREATMENT 4� ------------ EP IC TA!NK t r Ca aca �- Type - -" - Materi 1_�P17=�� No. Compo #ments --- ---------- P Y � e 1 i rokistoncef to nearest: Well ------------------------ Foundation G�--------------- Prop. Line A47...--- •---•- 1 s _ Total Length ------------------------- NE --------LINE No. of Lines - -- ---- ------- Lse�ngth of each line.___ I e Qepth Filter Material ' T ,n Fiit�r erial .e ti D' Sox - YI? i Propertyine. I Distancelto nearest.. Well ___ or ation __ ------- E/ No 0 "__-- Diameter u .ber -__t�--------------------- Rock Filled Yes ] R SEEPAGE PIT {�`l Depth _ s , ------------ � Rock Size --_"------------- Water Table Depth -------��-----------------------•---- ; ` Pro Line --------------------- m.istancl.!to nearest: Well --------------------- undation ------ p. i REPAIR/ADDITION(Prev. Lanitation Permit f -------------------------------------------- ------------- - --------------------------------------I ------------------------------ Septic Tank (Specify R equirernients) --------- ---------------------------- a -- - -- - - - -- -- ecif Requirements) "-- - •--------------- t Disposal Field {gip ------- q ------------------------------(---------------------------------- -, t - l xis "t; (Draw a ��!!''''�� --------------------------------------------re ' --- -�---- - ------- ----------------- -~ " � , � 1•i�ig and required addition o� reverse side) - I hereby certify that 1 have prepared this application and that the work N'be done;in accordance with San Joaquin County Ordinances! State Laws; and Rules an Regulations of the. San Jjgi'in La�W-Henith District: Home owner or iicen- sed agents signature certifies the�following: I shall not employ any person in such manner `I certify that in the performance of the work or which this'permit is ss ed, as to become-subie�t to Wok s Compensate fin laws of C3lifornsa ''' _ Owner j i --- ------------ I Title __ . t �� - - .--..------ - - (if oth, han�own er) } i © EPARTMENT USE ONLY + - DATE ------ ^ ---•--------------- APPLICATION ACCEPTED BY__-- -------- - — -_: - ---------------------------- DATE ----------•- ---------------------- UILDING PERMIT ISSUED . " -_" --- -------- --- ADDITIONAL COMMENTS'-.-,!--l------- --------- -- -- -�_ --- ---'' -----,-- ----- ------------------------ ----------------- ---------- --- ------ - ------------ i ----------- -------------- - t -------------------------------- --------- #. "" ------ I I.�-`-- - Date-_--v?-- --- - ---------- Final Inspection by:t_ ----- t- t AQi71N—LOCAh7HEALTH-r DISTRICT. ..„_... I t [ b, •I E. H. 9 1-'68 Rev. 5M.