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i r FOR OFFICE USE: pppLICATIdP. OA SANITATION PERMIT a S' . :. Permit No. - ---------- - ,ct,,np.ate in Triplicate) , Date Issued -3---------- -------------------------- 3 ' _ ---------------------- P a ". - . This Permit Expires 1 Year From Dale Issued Application is hereby made to the Local Health District for a permit to construct and install the work herein , described. his ti is in corrip h C ty O i ante No. 5 and existing Rules and Regulations: �� y ------ -- ----CENSUS TRACT S1-7----------- DRESS LOCATION __- A14- --- JOB AD --------Phone Owner's Name °�- 3t , ; E C -------- ------------- ity - s:_ -------------- - --- -- Address .__ _ `�-- _ 7/-'0 2.- Phone --.License # - Com. - f Contractor's Name ------- iz_ - �- Installation will serve: Residence Apartment House❑ Commercial []Trailer Court C1 -,Motel ❑Other -------------------------------------------- Garbage Grinder _.---__--- L'ot Size - Number of living units:__-_.._-_-- Number of bedrooms ______-___-- Private ❑ " Water Supply: u I Public System and name ----_----==------------------------------ Y Character of soil to a depth of 3 feet: Sand❑ Silt❑ Cloy ❑. _Pent ElSandy Loam❑ CI_gyoatn;Q Hardpan Adobe '❑ Fill Material ------------- If yes,type --------------- p ❑ (Plot plan, showing size of lot location of system A'in relation to wells, buildings, etc. must be laced on -reverseside.) �+}t � •- it perm if public sewer is available within 200 feet,)' ,,NEW INSTALLATION: (No septic itank or seepage p p ' ize - �- -Z------ Liquid Depth Z-�2 �.PAC1<AGE TREATMENT { ] SEPTIC TANK —2--- �.( ? -Material ° Compartments ------------•- Capacity,t-- ------ ----- TYpe -=---- �� O � ' r Foundation ---- ------- Prop. Line ------------- L Distance•to nearest: Well __ ------- �__ Total Length c �------------ Length of each liner ',I h LEACHING LINE No. of Liles _ __ 'D' Box _-__ Type Filter Material��-- -- p Iter Material ---,f -------- ----- / � r Depth � � �--- Prope Line. .�---------------- ------ Foundation --- ------- pY Distant to nearest: Well ---- ---- ^- / R�oc/k�-/) F il Ied Ye s-• / o p Number ------- SEEPAGE PITi _ze Water Table Depth -----------------------------Rock Stion ��FoundaProp Line-6------ ----- I Distance to nearest: Well ------ ------ Date ---- --------- REPAIR/ADDITION(Prev. Sanitation erm� ----- ' Septic Tank (Specif Re uirements) ----------------------------------------------------------------------------------------------------------- -- ----------- � q pis oral Field (Specify Requirements) --------------- --------------------------- , ------ . l -----------------------------r------e i- ------ P -- ----------------------- � {Draw existing and required addition on reverse side) nce I hereby certify that I have prepared this apph Son Joaquin tions ulat'onsn and tof the Son Joaquin Local Health Distrhat the work will be done in ict. No-me'town r or liicen- C.ounty Ordinances, State Lawsrjand Mules and R g -� sed agents signature certifies the following: arson in such manner "I certify that in the performance of the work for which this permit is issued, I shall not employ any p as to become subject to orkmc n's Compensation Haws of California." I Owner Signed ----------------------- ----- -- ------------------- ((fo _ ----- --- Title ------ - - -- -r t (If other t now er) FOR EPA1l11,11Af SE ONLY DATE _�___ APPLICATION ACCEPTED Y . ------- ------------- DATE -------------------- - BUILDINGPERMIT ISSUE -------t---------------------- -------------- ----- -------------------------------------- -------- --------•------ ------ ADDITIONAL COMMENTS -------- ------------------------------- :----'} - - -- ----------------------------------------------------- ------------------- ------------ - -------------------------------- --------- ------------ a5� ----------`---- --------------- -------------------------- --Date . ---- -- --- - Final Inspection by: --; _��e��;,4--`-------------------- - ----- ------•---- - -- ------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT�� y r u 0 1-'68 Rev. 5M