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FOR OFFICE USE: n2 APPLICATIOWFOR SANITATION PERMIT r!i • _ •, : `I^ jam : Permit N ---- ----------- ; - - -- - ~--• """ "` ` (Complete in Triplicate) o X16_ _-___------------- - This Permit Expires 1 Year From Date Issued Date Issued j Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein .h described. This application is made in compliance with County Ordinance No. 549 and existingR les and Regulations: 4. JOB ADDR SS/LOCATION` I --A ------L ® � "_JC� T _ �--- 1 - � gC _ Owner's Name .-. 0 _ r ' ----------------------- yPn 71-7 -{---.-. ------- --- city---- itY -Address ' i --- Phone -- Contractor's Name - -- -- --- E. fene #� �, �9� lnstallation'will serve: P Residence ❑IApartment House E Commercial;❑Trailer Court ',❑ �`^'•� �"+=_ ` �,,,.,,� `�.. k� l,+ia"„�'_,.. f+ Motel Other -- -�T.r.. .•.� �� ' I �•, ,� Number of-living units:.-- -._ ____ Number of bedrooms ____ "Garbage: .Grinder ______.____ Lot Size ./TC_ 't-_ f- -___._.-------- . � t - Water Supply: Public System and name ' ! "" ' Private _____________ ____ __ ___ _�- - T ..___ £ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ tPeat❑ "Sandy Loam ❑ Clay Loam "❑ i Hardpan ❑ Adobe Fill Material ------------ If yes,type A----------------------___ (Plot plan, showing size of lot, location of system in relation to wells, buildings, 'etc. must"be placed on reverse side.) ^� , NEW INSTALLATION: (No septic tank or seepage4pit permitted .if public sewer is available within 200 feet,) r l PACKAGE TREATMENT { ] SEPTIC TANK "Size_ .._ __ ___ __________________ ___ Liquid Depth .__ __--_____.____.__ CapacitType.' --- ------------ ateriai_- No. Co_np.adments Distance to nearest: Well A� �____-__.-_-_Foundation __..A7---- Prop. Line _4r.�______________ LEACHING LINE :. :.[�No-�of-LinesJ"a�—__��Leng#1,� eain�l"e.=______ _ ----------- Tatat Lehi �ffi��'.....__ �1 �T- lter Material _._ ---------------------------------------- Distance \l ` s � 'D' Box --- YP i � ""��------------Depth Filter Material __________-- ----•------- ' Distance to,nearest:-Wrii� • _ '' F-"-"� - e - - i SEEPAGE PITT Depth: -- oc , _i No I❑ Water-Table Depth - # - _ ... _ Distance to nearest: Well -- ` ou a 1 e ---------------- REPAIR/ADDITION(Prev. Sanitation Permit x# -------.------------------------------------- Date ______-___.________.____________-_J Septic Tank (Specify Requirements) ---- --- -------------=---------------------------------------- DisposalA Field (Specify Requirements) --_h _ _, -_,.------ - - iC--°---------s�--92 ,- -,-:--------- = -+---Z' -`-�- � �4 �--r.-r� --------------------- ------------------------ -------------\-.------------ ti czt-k;.------------------------------------------------------- ----------- ------------------------ �� (Draw existing and required addition on reverse.sidel I hereby certify that I have prepared this application and that the work will be done in accordance with Son Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: r "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 bec ubjec o Wo man's` ensation aws of California." Signe R� f------------------- BY ------- ---- Title f (If other th owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _-__ - -,�" ------------ # ----------------- DATE '. 1_ ��'-- - -------------------------------------- ' ------------------ ----------DATE ----------------------------------- ------- BUILDING PERMIT ISSUED ______________________ -._-_ ADDITIONAL COMMENTS __---.-___. rt ;�'+..L_ - t: ---------- ----------- ----------- ---------------------- ----- -- --- --- �`- ------ '= ----------- ---------------------------------------------------/-/----- i C� Final Inspection by. ----------- - --------- ' -----Date --- - ------,GR. SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M