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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. -"� •--•-•-•--• �� -• .0/.-�5.7. (complete in Triplicate) � � Date Issue ..... .......................... .......... This Permit Expires 1 Year From date Issued truct and l the work to consl hereby made to the San Joaquin Lova! Health County O for No. 549 and existing Rulestaind Regulat ons, tein Application is h y described. This application is made in compliance with County CENSUS TRACT .......... ............... / .. ......- ._.._. �...... JOB ADDRESS/LOCATION ... T Phone ... Owner's Name ...... -........ .. _...._. ................. ° City Address . .. . License # Phone �- -- Contractor's Name ...-- f�` Commercial []Trailer Court ❑ Installation will serve: Residence APartment House ] Motel ❑Other -------- -------------------- ��d .. x.44...._...... ----"-- �- lot Sire .. ............ _)--_-Garbage Grinder - Number of living units:....:_ - Number of bedrooms ._. __..._-- Privote,w ' Water Supply: Public System and name ..-... - PeQt I] Sandy Loam C1Clay Loam Character of soil to a depth of 3 feet: Sand Silt❑ Clay [] an ❑ Adobe :• Hardpan �` Fill Material ...._.----.• If yes.type ........... .... .. ......... k showing size of lot, location of system in relation to wells, buildings, 'etc: must be placed on reverse side.) (Plot pian, 9 NEW INSTALLATION: (No septic tank or seepage pit putted if Public sewer is available within� g2 200 feet,) 1 / - SEPTIC TANK f )�/.Tri �fze- ----------- -�- : . PACKAGE TREATMENT f ] . No. Compartments ._.... ... -• Capacity .. Type ---.- 3 Material....-..--- -- ----- -- ---- Foundation ...._.. Prop. Line ---------- Distance to nearest. Well T Length of` ach line.- Total Length _.. .............. LEACHING LINE No. of Lines- _.. � Depth Filter Material -. -. .- •••-•-- ' 'D' Box-.. Type Filter Material . p --- r - Foundation ...�- ----".-_.. —Property Property Line ________.-- Distance to nearest: Well ..� -- Rock Filled Yes No Q / Numbe, - ..... { Depth ./Q Diameter -- e �_ Rock Size _... ._ --------- Water ---- r Water Table Depth f� Line ...%S------------ Foundation l / Prop. Distance to nearest: Well "-__--. Z -------:Date ----------------------------------- REPAIR/ADDITION ------•-- -•------•- REPAIR/A DDIT ION Prev. Sanitation ement permit`#::::---•... • . ..... ..... ------Z...... ...........---- ------------ Septic (Specify . !�- -- ._.._ .-.._- F Disposal Field (Specify Requirements . _ , I -------------- ... ... ...... .... - •. 9------ ------- � {prow existin and required addition on reverse si e � (icatian and that the work will be dare in accordance with San .Joaquin I hereby certify that I have prepared this app i County Ordinances, State laws, and Rules and Regulations of the San .Joaquin Local Health District. Home owner.or Icen- { sed agents signature certifies the following: arson In such rn or "I certify that in the performance of the work for which this permit is issued, I shall not em play any P as to become subject to Workman's Compensation lows of California." .. Owner Signed ...... ------ _ - ._. �- �... 4 By If other than owner) y FO DEF USE ONLY — �- i DATE _�7.77........ DATE . ._:..-- = APPLICATION ACCEPTED BY ... ... e-. '- BUILDING PERMIT ISSUED ------ ._. - ADDITIONAL COMMENTS .....:. ..-- ..- ...•--------•-- - .............. g ...... -••............ ... ...' ... .... _....... _.._..Date :. - ----- "---- ---- Final inspection by: I SAN 6JOAQ LOCAL HEALTH. DISTRICT 723M