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-fICE USE. APPLICATION -FOR SANITATION PERMIT ._ Permit No (Complete in Triplicate) ;. ------ p - /:.- S � Date Issued --��-..... -•- � This Permit Expires 1 Year From Dato Issued ; Application is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work herein r , described, This application is mads in compliance with County Ordinance No. 549 and existing Rules and_Regulations: -r,> JOB ADDRESS/LOCATION .__ - •----,---- --- � .---- .-,----CENSUS TRACT s �—• - I1_ _ Owner's Name ----D� �. .__.....Cl9t!�t- f - ..---...-•---•- ----•- ------------------Phone... _ L. q Address ---------FR ------W-_-.6/...10 IPE i�]�.. City f +' --•-•----•---------••---- -• -• -- Contractor's Name ------49W41 =--------- --------- -- .....-License # --=----- ------- ---- Phone -------------_---------- ..... Installation will serve: Residence RX'p—artment House❑ Commercial❑Trailer Court ] k S Motel ❑Other----------------• ------------------------ Number of living units:.---- N ber of bedrooms :Garbage Grinder ------------ Lot Size __:.- -..-••••- ••• .....i Water Supply: Public System and ,�,n,�a.e' -• Cloy- Peau v - Prrvate ❑ I S�It - --L „Character otsoil-to a_de it of 3.:feet:-Sand.Q ❑ y- - t❑7 Sandy- ry' .H dpan ❑ Adobe' Fill Material 49-:- If yes,type--------- ------------------ { J (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 seepage pit permitted if public sewer is available within 200 feet,) , a` PACKAGE TREATMENT [ ] SEPTIC TANK [ ] Size-------------- -- . ------- ------ q p / s Li uid Depth . 11'/ -------------- Materia!--:------------.------ o. Compartments ' ' Capacity:--=�-------------•-- Type - - •- Distance to nearest: Welles. a-_._:__.__- •-=•• oundatian __.___ op. Line ----...._--- r_ •• LEACHING-LINE..�'.['��.'-No:of'lines = LeiSgth� ec[ch"line 7iiYcfil""L'e�ngth _.. ------------- ----P-roper . --- -.. 5 r .Depth Filter Ma rial ______________ -� 'Q' Box .---------•- TYPe�Filtery ate�ial ---------•--------• Distance to.nearest: We ' ion-----_--..----= Pxaper Line. - --- --.•....N .. O •----------- Foundati r . SEEPAGE PIT [ ] Depth -------------------- Diame r ... ............ Number ------------------------ --- Rock Filled' Yes [] ❑ _ after Table 13epth - - Rock Size _ ---- - --- p oP Qis'fiance to nearest: Well -- _ -•.-- Foundation __.._ =-•-..- r Line ---•.---------•• ;•- - ) `c ,t 1 eR7EPA71R�/ �DIITIION(Prev. Sanitation Permit 5l� • Date �5. I ptc Tank (SpeciRequirements) r Disposal Field {Specify Reg uirement-s)•:.:_ T. M_P-...47 - - - - - -- - spprno y�. (_Draw ezistin��and`required addition ori reverse-nidi') t a f hereby certify that�Iwhave=prepared this�opplscationjand that 4 work will be done in accordance with San Joaquin County Ordinances, State LcwsJ and Rules and Regulations bf the San Joaquin Local Health District. Home owner or licen � sed_agents signature_certifies.thefollowing• �_*,. - "I certify That-in the perForman��` ce of-the work ktarAwhich 4h4s)ermi is issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws ofXA!ifornia." Signed --- -------- -------------- ------------- ------------- r -j'7i� _ Owner 1 i ev +$ Title.. F - � '-- =- --------------- ----------- _777 AJ B --------------------------------- a j � _ A � 4 - (if other than owner] .FOR DEP�►RTMENT USE ONLY 1 _ --�-� w DATE APPLICATION ACCEPTED'BY _-_---f -, - -- 8UILDING-p-ERMIT ISSUED�� _ ---------------.-DATE - - s ADDITIONAL COMMENTS ___7_ _ '- 1 iI - -------- -------------- -:-------- r x //may r c - ----------------------- f T p. �- -� ----- - �� ---- ----------------- Date ,3:-Z_ - Final inspection bY- ------------- ------------- .�.., -�`'--------�------- - ---- --- - --- -SA tJOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M