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LOFFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No(L/-� . ....s........-"•............... (Complete in Triplicate) f Date issued...."----...•.....---_--- This Permit Expires 1 Year Frem Date Issued._.._....-.........._........__ - .. Application is hereby made to the Sa Joaquin L=1 Health District f a permit to construct and install the work herein de Thi;pgplica ion is made co 1i4 �vith C nty ° °e No. 549 and existing'Ru1es and Regulations: Sv / �" 1✓te " .. . a. ►? CENSUS TRACT �- � �- - : JOB ADDRESS/LOCATION one............-.........._--------.-- L/_ - Owner's Name ....... ...... - �• D ....._........... ..__. Address -...--- -- -3. 1J(.•i'•�1.:...;-• 5.4--'---c;;,Gify�- .-�•-�` 1-------•---•- _._....- c?4 ZA..e. --- -------...._J.. l}, 9Fz y� y 44.l:.J Contractor's Name -- U419' -..... Phone Installation will save: 1 Residence p Apartment Houser]Carnmercial Effsail ' Court 0 s �/Q�e1-. �Cr t r Motel ❑ ef------- , . - / 3 .9: ...--'-•--• Number living units:---'----. Numbef of"bedrooms --�-Gp�ge Grinda --".. Lot Size ..._f.__.---- '----- 1 .....---Private @� Water Supply: Public Systema name -----.---------,--.._.. _ Character of soil to-a•depthof3•feet:—Sand{, Sift QA Clay© �JR&at04"SOndyloom4P, Cloy Loam.( - Hardpan [] Adobe ❑ Fill Materials'_-._--.. If yes,type ..�----��-------------- ide.) (Plot plan, showing size of lot, location of system in reiation to wells buildings, etc. must be placed on reverse s ))) rt permitted if blit Qsewer is avgilable within 200 feet,) `y NEW INSTALLATION: {No septic Tank or seepage P P Size -Y— (� t/--__...., Liquid Depth -...:Y.9----••- -- a SEPTIC TANK 1 ] j Size... - ^G 7�_Qr•. PACKAGE TREATMENT [ 1 �- � --Z'=<--•••••-- CpS)._. Materiaf�!!�Ms�l3-,. No. Compartments � . Capacity�I—_.....--- TYP° - ..- Prop. line_.._-�.,_:_._-.. --------'--------..._Foundation - / Distance to nearest: Well......&A_ Total Length ._l.>-- -•••-•-- No.•of Lines - ---�. Length each llne.___.�9Q----- -7 LEACHING LINE ( ] ""' ISJ�.--....Depth RRei Materia ._-- - ------------------_-., _._. •D' Box ...r_.-• Type Filter Mater --. FaundaYton ---••-• - Distance to nearest: Well ...r1.------_-- - Rock filled Yes 0 "a O Diatnetar :__.._.----• Number .__.---------�--....--- SEEPAGE PIT [ 1 Depth ...... -_""" ` I - Water Table Depth -..-- - ....._-._............. t Distance to nearest: Well .__........_- Fou ' A�/ADDiT a"(Prev. Sanitation Permit tit ----••--•-••---: 1 ----•---------' Septic Tank (Specify Requirements) ---...._._.- .- --- -•- uirements] .._....----..__.--•----- -...-•-----•---•------••------•---•-----•-- .........._._....._ Disposol Field tSPeCfY E�9 �` - - -- -- r.:.. --z..-- _'._..-:-tee_.--------- - { -------^••-'-- � (Draw existing and required addition on reverse side) f ccerdmtce with San Joaquin 1 hereby certify that 1 have Prepared this application and that the work will be dine in ans oor ticen- i County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local 9Health District' Homo ow r sed agent sign certifies the following: ermit is issued, 1 shell not en'Pl°y air person in such manner "I certify hat in the performance of the work for which this i California.- as lifornta:' as to befewte sub'ect to Work n's CnpensaJiott / / caner - - - O Title Signed �. v~ - - _.. By . - (If her than owner) , FOR DEPARTMENT USE ONLY DATE --------- ......__.... APPLICATION ACCEPTED BY__ J.RZ!..................._ ------ ----_- .....__.. - DATE -.._L-�.-.L-5--.-.6 BUILDING PERMIT ISSUED-------- - --....... •--- ADDIT- - - ........ IONAL COMMENTS ---••---- ---.^-'.•-------------••----•--.....--------...__._..__..----...----._....-----_- • 7 • --- ' R-. -.-.... .... .. .. . - .............._.._. . .-...Date - _ - F- Final Inspecttonby:__ ....... -• - - ' SAN JOAQUIN LOCAL' HEALTH DISTRICT ' E.H.9 1-'68 Rev. 5M. _