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FOR OFFICE USE: ,APPLICATION FOR SANITATION PERdill' ti i Permit No. ...............7.5 ................................ .................... (Complete in Triplicate) ........................ ... ..................... 1 Date Issued ......5......... .................. �............... .-••---_... This Permit Expires 1 Year From Date Issued Application is,hereby made to the San Jooqvin Locoi Health District for a permit to construct and install the work herein r described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: l .....CENSUS TRACT .......... ............... JOB ADDRESS/LOCATIO � -- ..........Phone F6.f,77: ...... ............... Owner's Name -- # ............ C' 1' '�•� City Address . Ph ...... .. Contractor's Name ... s �.... -------- .License #X5 3 one 1-'P6-R(�`..7. Installation will serve: Residence ❑ Apartment House Commercial []Trailer Court C) -- r0-6I ❑` Cher ..�...... . . ...:..........:...•----------•- Nvmber of living units:.. Number ofl bed Garbage.Grinder Lot Size .._ L �. rooms Private Water Supply: Public System and namerti. =..,....... Character of soli to a depth of 3 feet: 5anc4;❑ _.;Silt[]. Clays.❑ Peat❑ So ndy.Loam,[:)— Clay Loam.❑—. .F a .......- -� .,.,Fil,i -..... If yes. type . .................. Hardpans Adobe - -' -- _ buildings, etc. must be placed on reverse sideJ (Plot plan, showing size of lot,ll cattion of. system in relation to well`s, NEW INSTALLATION: (No s ptic ta'hk or seepage pit permitted '+f public;sewer is available within 200 feet,] 1.�iF . PACKAGE TREATMENT': [ SETfC 4ANK j ] Size........._........................•.-.-....-• Liquid Depth .._.-.................... Capacity - TYPe --- Material.. ..... No. Compartments __-... ...... , - . 9 ....... .—Foundation ......... ....... Prop. Line Distance to•nearest: Well . _...._.--.--__- No. oVLine`s Length of each line.._... _-.. . Natal Length LEACHING LINE [ 1'r ,, I, D .-th-Filter-Material 'D' Bax ..... - Type Filter Material ........---•----..__ e`p t foundation Property Line ........................ Distdnce to nearest: Well. ...............:. ...-• `-- " ._._.. Number :tRock Filled Yes ❑ Na SEEPAGE PIT [ j Depth .D-iam'etier . . m - --" Water Table Depth -------------------- ..,,.IRock Size ........_---_...� ---••- { £ Distance to nearest: Well ------ --------•--•- F��ndation .... .: .. ... Prop. Line ...................... f - 1�ll ...... _ Date -_. { 1 . REPAIR/ADDITION(Prev.(PreySanitation Permit# _...---- --•- �- • - • _ , Septic Tank (Specify{Requirements i /'•Y �! - .. .. .. .................... Disposal Field', (Specify Requirements) !!! Y .� ... . ... . ... R ... ,.r-;.. ..� - --- ---- Jo q i (Draw existing and required addition an reverse side) P I hereby certify That 1 have,prepared this application'and-that-the work will be done ini accordance with San a un County Ordinancex, State Laws, and Rules and Regulations of the Sa nn'aoaquin Local Health District. Home owner or )item sed agents signature certifies the following: /f "I certify that in the performance of the work for which tiiisJpermit is issued,`l shall not employ any person in such manner as to become subject to Workman's!Cornpensation laws� fFCalifornia." ' ..r--^^-=-.-.Owner Signed .:.. ...... ................ .....1... ... . ....... BY ... ........ ...................... ------•-- --------- Title . `��'�I ......, (If othe an owner) + FOR DEPARTMENT USE ONLY'__ _ APPLICATION ACCEPTED BY ,_....._ ----•. . DATE ,..... . BUILDING PERMIT ISSUED ............ . t... --.... 1� -------- .. .� DATE ..... ---... •----••...... :._,,.-•� ADDITIONAL COMMENTS ... f a4`f a.. ........ /nc wr <. ..... ..... ... .:. r�o. "�* h --- -------- ,a-u. ---.-- , ---------------•...-. � .............. _ �J . - _ _ �_ Date 71 ------------------ Final Inspection b ..---- ...... SAN JOAQUIN° LOCAL_HEALTH DISTRICT