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FOR OFFICE USE: AZPLICL,'TION FOR SANITATION PERMIT Permit,No. - -� � ti ----------------------------------------------------- `E"_! (Complete in Triplicate , Date issued - '- '�� _ This Permit Expires 1 Year From Date issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Reeggulations: C•CENSUS TRACT S_` ----•- JOB ADDRESS/LOCATION .30 _Z -�-------coM� ��_.__�_._�_-- -- Owner's Names Com- 19 - --- ---Y-Aonel `�Z t • Cit Address .. -C'�LOVi J L. y ; r 2f I Contractor s Norrie .Ql!(.1.N_ _ _ __ _________________ - ------- - License # �' Phone -- -- -- ---- - --- Installation will serve: Residence u apartment House❑ Commercial:❑Trailer Court 1❑ - r_ Motel-E]Other yam_' /TC-f}� = g �_. _ Lot Size --------- ----- -- Number of living units:_._____-__ Number of'bee7�'ooms^-- --�--Garbo a Grinder _ _ ._... -� - �------------------------------------------� Private Water Supply: PublicSysstem and name ----------'-��-------------------C ; Peat Sandy of soil to a depth of 3 feet: Sand'❑ Silt[] Glay E]--Peat y Loam ❑ Clay Loam Hardpan P----"Adobe 0--m-Fill-Ma des;type --------=-=_ r� � W IPI'ot plan, showing size of lot, location of system in relation to wJlls, buildings/etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit-.permitted-,if'p#blic sewers available within 200 feet,) 11 PACKAGE TREATMENT { ] SEPTIC TANK:&4__-1_ i Size____ - --X- - Liquid Depth __ -._'2-��-------- \ i I .M,V � Capacity --- TYPe �R FF}I Material C_E W;Ff- = No Compartment �--:-----� Foundation 1,Q 1-'7`------ Prop Line -•-- f D ante to nearest: Well - --- �w --,; �� N •^ _r-- .�_ _--=Total Len th =_l___ `.'------- LEACHING LINE No. of Lines --------------- Length-of each line-- _ ------- g ,._.. . ., p ..`.�....--.:.....-- �- w D' Box Type Filter Material Dep#h Filter Material --- Type i - .......... � ` _ Foundation AP -- " -------- Property Line __J_.- - --•:---- Distance to nearest: Well 1 =- �• = � t1 X — - ----- Rock Filled Yes No i❑ Diameter I--------ZS----- Number ------------------- 1 SEEPAGE PIT [ ] Depth /_ -._________ ) ! ., ti Water Table Depth d_ F------Ro� Size t f --_---Foundation 1Q_____----•---- Prop. Line _._. Distance to nearest: Well __�� -------------- } I --- Date --- REPAIR/ADDITION-(P_rev.-Sanitation,.P_ermit#_---.----------------- - \ ----- ------------`l;-U1'! _-----------�_�-,-`.;- ---- Septic Tank (Specify Requirements) -.--------------------------------------------------------------- ---- p --------- Disposal fRiments) -----•-------------------- ------- t __.____-__._-_________ _Y --------______________________ _ --------- __3___ ----------------------- ---------------- --------- ---------- ____-__- - ----------------------- ------------ _---- _______. - ___ - ` •. ----- (Draw existing and required add itiiYTq� rev,;rr a .� .e. s: I hereby certify that I have prepared this application and that the ro�tc willfbe done .in accordance with San Joaquin County Ordinances, State laws, and Rules and Regulations' County San)loa�quin Local'He' DatrEct Home owner or liven- - 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 person in, chmanner T4r� �� .� Ms + as to become subject to Workman's Compensation laws of California." ,}W I ---------- - Owner + ---------- Sign ------------ J Title = t = 1� ' (.� eri -------- If other than caner) j . t- i FOR DEPARTMENT USE ONLY r 7 f APPLICATION ACCEPTED BY - - -`C1/ ---- ------------------- DATE-,E�.`- - _`€z -. BUILDING PERMIT ISSUED ------------ -------DATE. :_-------•-•----------------------------- - - -- ---- - - -� - ------------------------------ - ---- -------- --- ADDITIONAL COMMENTS _ _ . ---------------------------------------------------- - ------ - _ - ------------------------- ----- ---------------- _ --- s _ - . < 'e _ _ _�� .Date ------------- - Final Inspection by: SAN J6/�Q111N`Lf� -- _A_ CAC NI:ALTH'DSTRICT r E. H. 9 1-'68-Rev. 5M j