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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT d G Permit No. -_7.G ••••• - ....... -'- (Complete in Triplicate) --- »__.._......._. Date Issued This Permit Expires i Year From Date Issued A loatton is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein d�tbed.This application Is mads in complkmM with County Ordinances No/549 and existing Rules and Regulations: /� rz %/ -. --..._. --CENSUS TRACT -.---------- ------- -- Me ADDRESS/LOCATION _._...V.G_-..2a_ot_.--_�1e .__.yam•- " ---Phone .�• C ..� 1 Owners Nm^e ��.__r!✓�'/�� Address ........ '�!�iFtti ------------------------------------------------.-- .............city - ---- r7 �9:_l Jld contractor':Name-, - � •-- Residence❑Apartment Housso�)Mrolfercow instaltatlon wiB serve: '40G Motel ❑Other------------------ »' J -------------- Number of (wing units:..__,..- Grinder -`-------- Lot Size -5-Number of bedrooms .._._.------Gorboge --._--�� - -- - Loom D Water Supply Public System and name ---------------- Peat[3 Sandy Loam 0 Clay �. Character of soil to a depth of 3 feet: Sand❑ Slit❑ Clay Hardpan❑ Adobe5d Fill Material _.._.......If yes, e.l type-----'-'-'-----'--•--- ldings, etc must be Placed on reverse (Plot plan, showing size of lot, location of system In relation to wells, buisld NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 400 feet,) O ! s ~ Size-- "y jll !2-, -sf- Laqu d Depth _..u-a- PACKAGE TREATMENT [ ] SEPTIC THANK t ) p compartments __,— Capacity .�(r ..- Typs/cyec.Q�?maler(al.------------------- Na. Foundation-------------------- Prop. Line..... Distance to nearest: Well30.0— LEACHING ..s Y Total Length .3�•--•••-- r t--.--' --------- ee No. of Lines - -- -'------- I � each Ih're-- - -- LEACHING LINE [ ] ` Mor Material ��J - , -------___..........._- Depth Fitter Material ----� -•-'- •D' Box ---/----- TYPe pe Line ..740.----.._.. _ Foundation .c.5-d------•••--. Property Distance to nearest: Well _l�,a,,. •--- Rock Filled Yes 0 No Q Number Diameter SEEPAGE PIT [ ] Depth -------------' - ------ - __ - _._._._-_Rock Size -------_.___._.----- Water Table Depth ------- .. ...... Prop. Line -------- »..»_...__»».Foundation --...-----. Distance to nearest: Well _».._...-»... ) Date REPAIR/ADDITION lProv- Sanitation Permit 0 _. -... _-... »»..»...._...».» _ of Requirements) -------------•-••'---------..._.-.-.-- ..... ---. Septic Tank (Specify _-.>--_-•----•---'---------•-------»'---_..... iremerft) ------------------------» Disposal Field (Specify Reu _ ._»..--•.--'- '-' . �. ------------------- - -- - uired additSon on reverse side) .._____ . - and req -----------------------...:...._. (Draw existing PreP� thb application and that the work will be done in accordance with San Joaquin I hereby certify that I have R uladol s of the San Joaquin Local Health DisMet. Homs owner or Bun' County ordinances, State Louver cod Butes mrd e9 sed agents signature certifies the formance Of they work for which this permit u issued, ! shall not employ arrY person in such memrer -I certify that In the perform Compensation laws Of Callfomia. Owner man's Comp as to become wbjeef _ Signed ...-.. '` ..i ...r- Title By ------------------(if other than owner) DEPARTMtUSE ONLY -.s------ FORDATE —_-__--- APPLICATION ACCEPTED B------- .- r -------------------------- ------ -----_.___--- DATE . ----------------------------------_.. BUILDING PERMIT ISSUED --------- — - .-....-----..--............ .......... ADDITIONAL COMMENT$�� -•-----.-_..----'•------`----_.-..----_......__--------••..............�.._.__.....- - - = - __ - ... ............... t - _.. Date ... ...------ - - Final to - � �-.- SpJ.l JOAGFUIN LOCAL HEALTH DISTB IlU E. H- 9 1•'68 Rev. 5M