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:x FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. -• � iCempiete In T*ipiicatel � - Date issued This Permit Wires I Year From Rate!:sued . Application is hereby made to the Son Joayvin Local Health District for a permit to construct and Install the work described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulcrt! n s JOB AUE7RE55/LOCATIONJ— .� :-�J...111(4,). ... .............CENSl3S TRACT .............. �Y. f Phone .................................... , Owner's Nome� � , /:� . �.... . .............. _.City ._..f .............. .. Address ... .. ..._.... .......................... ._ Pone ._................... Contractor's Name . ..._. a , License* Installation will serve: Residence 0 Apartment House 0 Cmmerclal oTrailer Court 0 Y Motel I-1 Other •••k'-Y•`rtQ Number of living units:.. _� -••-••••- ..... Number of bedrooms ••• Garbage Grinder ............ lot ze ....._ .......PrivateR .. (. .. Weser Supply: Public System and name .................................. . .•,.:°. , Character of soil to a depth of 3 feet: Sand[] Slit❑ Clay P+tat❑ 5andy Loam Q Clay Loam[l Fill Material ....... .... If yes,type.......................... . v Hardpan❑ Adobe C3 � (Plot plan, showing size of lot, location of system in relotton to wells, buildings, etc, must be placed on revue side.) + at ermitttd if public sewer is available within 200 feet,) V NEW INSTALLATION. IN- septic tank or seepage p P � � f •rf� ,r�,�.,...r.��` ..........._ Liquid Depth ..... ......... R ' SEPTIC TANK Sixo.. . PACKAGE TREATMENT I I .. } ' No. Comparhnenh .. a Capacityl. 11a� TYP Litre................... . r ....._.Foundation ..-f".iD.�... •.• p � ��.......... 4, Distance to ne rest: Well .`�� pP LEACHING LINE �� ^ No. o¢ Lines -- ...../............. Length of each line...../.. ca Trial Len .�-?.r.R�'..._..Depth Filter Material .._..�.g..��...............r.......,... 'D' Box f.... Type Filter M0terlal line ...��.... Distance to nearest: Well C',.t._..._.. Foundation _....j.0..:.......... Property .2 �' r Number /.........�........ Rock Filled Yes Eq' No [] s W -� -.. .. Depth _...1�... �......... �; ' ,rio � ....Rock Size ..�.•�-••••X••�••••• i M1:, Water Table Depth •'•-•" Line `r __ � �..�.::... Prop. ...................... r Foundation Distance to nearest: Well .........��.Q.....:�.... REPAII /ADRITION(Prey. Sanitation Perrrr•di`......--•...........' ............ Date _..................:..............I Septic Tank ISp fy q eci Requirements) --•• .............................................. .�; Disposal field )Specify Requirements) w ...........'............................................................................. .... :....... .-•._.__..- ............................................................................................................................... -- --�- -� -' •.. . (Draw existing and required addition an reverse si e will b* done in i hereby certif7/ that i havh San e prepared this application urns, that the wuin ork Joaquin total "000th Ris riet.ni{etr.ce towner e,��' I herey flrdinan that State Laws, and Rules and Ragulatiorts of the San ieaq � sed agents signature certifies tho following: le ersen in such manner „I certify that In the performance of the woak for which this permit is issued, I shall not ompy any P as to become subject to Workman's Compensation laws f Cailfemla:' ' Owner signed .. �'�.. .._. --..... .. Title ... lay �tf other than owner FOR DEPARTMENT Ust. ONLY_ ...................... DATE ._.. ..........._........................_. I APPLICATION ACCEPTED BY ....... ............................. ...........- ........DATE ........................................... BUILDINGPERMIT 155UE0 ---........ . .....-._".................... ._ _. . ....-...._..._.........- .. _.._..._............._....._..._........_. ADDITIONAL COMMENTS .......................... . ......._ i ......_...'. ..._... _...........:................................................................_.... ....:... -:.....--j ... a .._.... qCDate -Y— Final Inspection by: . ..... SAN JOAOLIIN LOCAL HEALTH DISTRICT ¢� E, H. 9 1-'68 Rev. 5M