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FOR OFFICE sf : APPLICATION FOR SANITATION PERMIT Permit No. ---------------- (Complete' in Triplicate) G l7- ------ Date issued ------------------ m� - -------------------------------------------------------- 'i This Permit Expires 1 Year From ate slue .,� with Count .Ordinance No. 549 and existing RuleslcV Regulations-. Application is hereby made to the San Joaquin ocal Health District for a permit to construct and install the war �7herein PP described. This application is made in compliance � � ----(-- ArH.R-0- �--,r----CAEN�SU S TRACT __ ""-".-"^----------- ------`-----vVSJ ------ JOB ADDRESS/LOCATION _ •-"-- r� Pone -----�------------ Owner's Name --------------ill�J_f1"Pt1.41 Q_--=_;----D -f�Y" = j --- Address Ham, _- Phone � _ Contractor's Name rv1�1!1r1 ------'�-Cr•------------------ License # - =•` Installation will serve: ResidencelflApartment House E] Commercial []Trailer Court ',[I Motel ]Other ...... --- ------------------------------------- �-- Garbage Grinder .��--- Lot Size. _-- .-- � Number of living units:."_------ Number of bedrooms ---- -"---- -------I----------private [� ---------------------------- Wafter Supply: Public System and name -------------------------- ---- -" Peat❑ Sandy Loam Clay Loam [] Si Clay'fl Character of soil to a depth of 3 feet: Sand's Hardpan ❑ Adobe 0� FilIrMater�al -. --- If yes, type \ `yt location of system in relatianrto wells, buildings, etc. must be placed on reverse side.] Ian, showing size of to , p / [Plot p ,t permitted if public sewer is available within 2b0 feet,) NEW INSTALLATION: (No septic tank or seepage p' P ' - Liquid Depth �f• Size"_--'� SEPTIC TANK.'[ ] ----�-�Q---�-��- ----- -- PACKAGE TREATMENT [ ) ----- ---- Ca acid TYPe?RE_FAI- Material""e0! :C -__ No. Compartments p tY . = - ---- --- -- -----Foundation ------ -----10 -- Prop. Line -----------`��---^---- Distance to nearest: Well --------------- +r _ _ ` -- _� �_ _ ,... a_ ._- l - Total Length -� , �..�_"_-" Length of each line__--- - -- LEACHING LINE [ ] No. of Lines ;_---.--- +. Type Filter Material ,_`_ --_De'pth Filter: Mafierral -f- i p Bo x�� { = Line // '1�-- -- Property - - -�- ------ -=--•- Distance to nearest: Well " ___-- Foundation ----------- I Number ------------ SEEPAGE --___ -- - - -'- Rock Filled Yes ] No - Depth Diameter ------------ I . { SEEPAGE PIT [ ] I Rock Size ---............................. �� Water Table 1,Depth ---------------------------------------- ---.�_._ _ --aProp Line ". -------------Foundation Distance to nearest: Well _--------- ti l # i -- Date ----------!----•--- ) REPAIR/ADDITION(Prev. Sanitation Permrt# _------ -------------- ---"" -----.__- I Y ' - - Septic Tank (Specify Requirements] _ .,__. ...........:..:. _,:. . C ----------------------------------- -------------- Disposal Field (Specify Requirements) - ----'----- ___.-" _ '' --------------------------- ------ __- --------- [.( (Draw existing and required addition on reverse, i ;f, lication and that' he-workwill`lie done in accordance with San Joaquin I hereby certify that 1 have prepared this.app i,' l County Ordinances, State Laws, and Rules and Regulations of the'l San Joaquin Local Health District. Home owner or icen- i sed agents signature certifies the following: t! employ y person in such manner "I certify that in the performance;of the-work for which this permit is issued, I shall not em to an as to be-o s 'ect to War an mpensation law of California." it 1_ 1 t Owner Signed , - -- -- ---- T c Title --------------------------- ------ B 1 - - - -- ,� -� a + If other thd�n own r,', a FOR DEPARTMENT USE ONLY . I DATE -------- -" -�- ' ----- APPLICATION ACCEPTED BY . +_ .4© t Y _a--_.---V.DATE_ - ~-:- `__---- i BUILDING PERMIT ISSUED__ ----' 0LEE _, c� \� ; ADDITIONAL COMMENTS --------------------- ------- __. .._ -- ---__-_w ------------------- --- ---- -- --- ---- ---- ----- -------------- Date ._- --l _�- -- ------- ---- - - - F Final Inspection by: -- - -"a_-- --- " ---------------------------------------- SAN -- - -SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M