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FOR OFFICE USE: gppLICATION FOR SANITATION PERMIT �j_�-jf Permit No. . ..-- -- -- _...-_---.--- •------- - (Complete in Triplicate) Date Issued . �--4-9 -4�7 ------------------ -- This Permit Ex ires l Year From Date issued aith and f Application is hereby made to the San Joang Minn oe l HheC u�yt0 Ordinance permit instal No. 549 and exting g RulesaindhRegulations., described. This application is made in co p ..CENSUS TRACT . -- JOB ADDRESS/LOCATION --. -- Phone -.4- - � ' ' ! Owner's Name -/�'4-!yl.C'. ---- - C •¢ -- -- ----- ------•.........-........ -- /� � _./ ./ 2 city ..�1./�. a ' J ! Address?l--- _License # > / 4?' --- Phone ---.---- -- .l� -r�----------- - Contractor's Name-`e - 171 installation will serve: , Residence partment House❑ Commercial ❑Trailer Court i Motel ❑Other ._....---f------- ------------ Number of living units:_-.-./__ Number of bedrooms _ __-_--__-Garbage Grinder __ ----. Lot Size r ..- -- •---.�.._...... _.. _ Private i Water Supply: Public System an name ----.----- y Cloy Loam,[] F: Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat Q Sand Loam ❑ .J - "Hardpan Q 1-❑ Fil!'Nkateriaf . .Q•.. If yes,type -------------------------- - -- . . Adobe i (plot plan, showing size of lot, location of system in relation�o wells,•bs Wergs'avaiiable within 200 feet}on reverse side NEW INSTALLATION: (No septic tank or seepa it permitted if public ! It Size__..� I� ��!`�-��-- Liquid Depth --�,�----- --- PACKAGE TREATMENT [ ] SEPTIC TANK; -- �------------- -- - moZ— !t rtments Capacity - Typel 4 Pro Line ---- -------•- V � _ Foundation ----- ----- -- -- -- P• - istance to nearest: Well V� r " - ------_-- Length of each line---. ---� r----- --- Total Length --/``SZS-----•-----•- k LEACHING LINE [ No. of Lines Depth Filter Material r 'D' Box jiF_5- Type Filter Material _.. --�' r fi-- Foundation ----PQ-.�` -- Property Line. ... Distance to nearest: Well _.__57- Rock Filled Yes C3 X10 ' Diameter ---------------- Number SEEPAGE PIT [ ] Depth'-.---- Water Table Depth --- ---- ------ Rock Size - -------------------- - Pro Llne .-.------------------- I r Distance to nearest: Well __-. ._._-. _••------------ --..-Foundation .................... P• t ----- -------------Date -------- ------------------ REPAIR/ADDITION(Prev. Sana ition Permit°# ---- - -•-- Septic Tank (Specify Requirements) -- ---- Disposal Field (Specify Requirements) ---------------------- ••----- ----- ----- _ _.. ------........................ ... ------ ---- ----- • --•--_.... Y _- ;� (Draw-existing-and required addition on reverse-side)--i application and and that the work will be done in accordance with San Joaquin I hereby certify that I have prepared this app 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: "I certify that in the performance of the work for which this permit is issued, I shall not employ any parson in such manner as to become subject to Workman's Compensation laws of California." i7 Owner Signed -... --- -- -- - ----- ----- .X_X ------ ! title ................ .. . --------- (If other than o;nor} y_— FOR DEPARTMENT USE ONLY =—— —3 ! . --- — ,� _..__.. DATE ...... --L t - .'--- --• •- ---• ------ -------------- ...._....DATE _.._:_.__.. ...--•- -•--•-•-•--•--•--•--•- APPLICATION ACCEPTED BY�._.. .......1- BUILDINGPERMIT ISSUED ___.------- •--•..-------_------------------------- ...........................----•-. ADDITIONAL COMMENTS �. -- ---------------- ------------------ -•--- •------- --------- ---- ....... -- 7— Q --------- - -- . ... -. Date I -• --------- ------------- ..•- Final Inspe'c7t�-Li�.� .. ---- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9. 1-'68 Rev. 5M