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T� FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT � Permit No. .7 ............. -- (Complete in Triplicate) Date issued -......--•••••••... ............... This Permit Expires 1 Year From Date Issued t Application is hereby made to the San .Joaquin Local 'H{ealth��i tOrdinoan a No"549 and existing Rules it to construct and tand Regulations'l the work t pp described. This application is made i A compliants w , JOB ADDRESS/LOCATION r � ......................CENSUS TRACT {- _Phone : .. Owner's Name ...... � C �!�✓¢ T 11 ................................................ ..----------•- .AddressCity erase # Phone r .3_�...... . ... Contractor's Name .._.....-'�° • ; installation will serve: Residence Apartment House Commercial QTraiIor Court '0 4 Motel ❑Other -----------------•------•------• ........... i .-- ~ =Number of living units:.--t..'�-.- Number of bedrooms ... -----Garbage Grinder ......_..__. tot Size ....--� ..._. .....Priva . t to Water Supply: Public System and name .......................•- Peat Sandy Loam Clay Loam ❑ ° Character of soil to a depth of 3 feet, Sand �] Silt❑ Clay ❑ ❑ Hardpan ❑ Adobe-Q Fill Material ....__�._... if yes,type --- ------------------------ • {Plot plan, showing size of lot, location of. system in relation to wells, buildings, etc. must be placed on reverse side.)6 i it permitted if public sewer is available within 20q feet,} �� } J NEW INSTALLATION: {No septic t!nk or seepage p' p , �--- Size---. 154. `'/..�..- •._... ... Liquid Depth ----.�.... ---------6 SEPTIC TANK-[ ] PACKAGE TREATMENT [ ] ........................ �' ••-• Type --- ......... ._.. .. Material.. .............:.. . Na. Compartments � k ,Capacity •--:- --.... I .. .......... ' Foundation ./a�............... Prop. line .. Distance tc nearest: Well ---/�'?--- 'e - ------- Total ten th ._:. . ........7 No. of Lines ................ Length of each line.---..' 1y T 9 „ ., a i tI;ACHING LINE [ ) - j al 9 Fi`"FiferMatsrial _...-.11-'•-•- D' Box Type Filter Material .-/-l�X,i? �D r Property Line ........ 4 " hW Foundation .. ..... .= Distance to nearest: Well ..l-�'---••----•---• -� umber . Rock Filled Yes Diameter N SEEPAGE PIT Depth 1 �? _..Rock Size.-----••----.....--•............. .. Water Table Depth 1 ' ..._.- S Distance to nearest: Well . ------••-•• Foundation Prop. ins -------------•-• ' Date .................................} s REPAIR/ADDITION lPrevSanitation Permit t Septic Tank (Specify"Requirementsj -----------•--- ---•--•-•---------------•------._...- ---- ....t Requirements) -•-•--••---... -•.................................... ...•--•----•••--•--••_..._. Disposal Field (Spectfy.� q 1 ....................... ............. Ida -------- ..................•---------------------............ ---•------------- ------ _..:_..._..A ............. 1 -..�_-..-----•--•--••...... ....................... `r "' IDraw e i iing.and required addition on reverse side) 1 ` . I have prepared this application and 1 hereby certify that that the work will be, done in accordance with San Joaquin , and RC Iesi and Regulations of the San Joaquin Local Health District. Home owner or licen County Ordinances, State Law - sed agents signature certifies the following,i arson in such manner 9 f I permit is issued, I shall not employ any p t °'I certify that in the performance of the warkfor which this f as to became subjectyWrkman` om ensation laws'`of California." ner OwSigned .....-•• -- Title .............:..... 1 i. ..............�....._....._.. (if other than owner) FOR DEPARTMENT USE ONLY -•... DATE 4-a-----z^•�- ......_ APPLICATION ACCEPTED BY `_ .DATE . r BUILDING PERMIT ISSUED --:....................................... ........:........... ......._.. ADDITIONAL COMMENTS ......... ......................_ _ _�.. _..--•.... .............. .......�� - -te n.... _..... __.............. .............. ,. ..._.......__...._._. ......................• -. ._._...- -........ L ........................ ...........Date ... ........... ----•---•.._.... Final Inspection by: ------ SAN JOAQUIN LOCAL HEALTH DISTRICT C`D 7/72_3 �K.�