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FOR OFFICE USE: APPLICATION FOR SANITATION PBIMIT Na, n iD� _. ... Permit . . .. (Complete in TrFpliwte) t _._ .......... Dote issued , __.-........._....... This PemtitEkpira 1 Yew From DOblssued D � Application is hereby made to the San Joaquin Local ealth District for a permit to construct and install the work heroin described. This application is♦made in compliance 4h County Ordiinnan-ce_No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATI 1&.91�..� �Jl �` 'p -rf' ...._.......CE _C7 ....................._..- V/Je' CENSUS TRA Owner's Name ................- ----- Phone Address ./. Q�a-.__ Q. .... - . .. .. .. ...... A City O .......... ...... - -- - Contractor's Name ....... .... 11cense#��0�-r Phone -------- Installation will serve: Residence Apartment House❑ Commercial[]Trailer Court ❑ Motel []Other..... ----••-----. ---_------------------ � � Number of living units:-- -I. . NumbVof bedrooms .....Garbage Grinder .. Lot Size .... ----- ' ---.-.-- Private 1p) Water Supply: Public System and name..__... -"-' Character of soil to a depth of 3 feet: Sand Q Silt❑ Clay ❑ Peat❑ Sandy Loam Clay 4bam Q TI .��HFtrdpan❑ Adobe❑ Fill Material ........ ... If yes, type ........-.--.--I------- (Ploti,plan, showing iize�lot, location of system in relation to wells, buildings, etc. must be PlaceQ on reverse side.) \ NEW IN6;kLLATIO1!I: �No septic tank or seep a pit permitted IIf ublic sewer er is available within Zf>D eet,l n PACKAGE_TR1kftTV JT'j-]- SEPTIC TANK{ �:rize- . �' Y ./ .. ........... Liquid Dedth ..!V....-...... -• Vl Capacity �� Type . Moteriict Comport, ants .....P�1+w--.-.••-- pa ty -- -------- 01 istance to near Well ........�., Q.............. .Foundation /Q.........__ Prop line ....._......_......-- t� o I LEACH( ,G LI E [�No. of Lines .....!�`yr-. Lengt of-eoch}�line._.a.0...-. -------.-. Total Leng,4 M J ✓ `� 'D• Box --.- ----.. ype FilteY�fll;iteriol -.-... . !�-..Depth Filter Material ._._.-1�.-----.-.._.-�........- `/� ✓ - - /.Q .0 Pro (line Distance t nearest• Well ...._ ... Foundation .... pert/ 1 SEEPAG PIT ✓ .v De Depth 1_. Diameters Number ............-_..._.. ...: Rock Filled Yes ❑ NO ![] [ ] P ( - - - J. Water Table Dep`It Rock Size .............. -------..... 1 Prop. Line Distance to nearest: Well ............. ..........•.•.---•-------•foundation ................... I.- 1 �. - ....n REPAIR/ADDITION(Prev. Sanitation Permit# ....................... .. ^Date-,—^.....--.......... ....... Septic Tank (Specify Requirements) _............................-................ ,,_;_, _ ---- ------------------------ ---- ----- - :-----....---..._.... Disposal Field (Specify Requirements) ••••••••^--•----'-""""-------" """-' (Draw existing and required addition on reverse side) dant -'~ ...---._....... ......_. . - PP e done In ace r -----"--- ... --- ........ .... ........-------------- - _ ...b!.... ,..—.._........... Coun ty b ordinances, StatevLaws and Rules and that the work will the San Joaquin Local Health h D st W. H i e owner San Joaquin Y fYprepared �me,thSon or licen- sed ! sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to beco v lett to Workman' ensati on lof California. Signed ....... .--. ... .... ;,aws .. owner f�—�4R.71F 4 y -_ _ - - - . .. -•.... ... . (If other than owner) FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY __ . .. . . .. -- _.... .. 1A APPLICATION .... ...................... BUILDING PERMIT ISSUED ._-. DATE -- �----------•--............... --------------------------------- ---------------••-- -- - _.. ADDITIONAL COMMENTS .—--- .................. •. ...----------- --..•............... - - - - - _. .....--. ......---•-_... •................... __....... -'--- - -......------.... Final Inspection by: . .. ... .... .................. ---�-----' Date 7 = -- -- SAN JOAQUIN LOCAL HEALTH DISTRICT E.H. 9 1-'68 Rev. 5M