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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ........... ..... ...... .,...F _ lCompleto In,Triplicate) .,...-.. PermN No. .., s ss:� .............................................. Date Issued ... .....I..... . ..... .............:......... This Parrot Expires 1 Year Prom Date Issued Appticotion'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 Regulations: / z ' z� o� �- � ,T.' JOB ADDRESS LOCATION...-•---•---.__.._. _................................. .....••---....._.-----. -.:.....................CE'hISUS TRACT ........................... Owner's Name ./��.� .............................. , �.�?!..................... ::.... .....................Phone :1 �1-_ .f��.1....._.. f r Address ..... i� ._ ..so..._. �-....�T..................... ...... ...city ._.�.��<��y�s��---- :.._.,._ /-J— .... Contractor's Name ...../it Vis....`s ...................•---•-...._...:._..................License# 1779 �7. Phone 7 5 'S Installation will serve: Residence R1 Apartment House) Commercial O. railer Court Motel Q Other Number of living units:... Number of bedrooms ...,.Garbage Grinder ...«.... Lot Size ...1_�C:�C......... ..,..:. f Water Supply: Public System and nameL:,...K.. ... .... . .... :_......:......:.........................».Private 0. Character of soil to a depth of 3 feet: SandE3 Slit o Clay ❑ Peat Q Sandy Loom {] Clay Loam ❑ Hardpan p Adobe 0 "Fill Materlal ............If yes,hype............... ............ (Plot plan, showing size of "lot, location -- - ' " on of system in relation to wells; buildings, etc. must be placed on reverse side.) r NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,j PACKAGE TREATMENT .14 SEPTIC TAt4K DO ' . �.....�..�..............••--. Liquid Depth .. .................. n r �� 'aC� � � U Capacity -------•...._ Type ...... . ...:.. .. Material_CA?.,.,_ T�fVo. Compartments ....�::. .. .. Distance.to neares : Well �..................Foundation ......... Prop. Une ../..-��........... . LEACHING LINE No. of Lines ....... ...:.........: Length of each line......f.W?ter �""��..�Tatal Length --- .,..-- --� 'D' Box .._ f..... Type Filter Material .�.�.IDepth Fi Materia! 4'..f .'.f' ., Distance to nearest, Well ....... Foundation ....:70?.7. .... Property Lina a SEEPAGE PET Depth ...�'- [�Q p ...... Diameter .. .... " mber ............/...... Rack Filled YesA No a. ......� Nu Water Table Depth ._...3 .�......_.......e.:.... ........—Rock Size ....L ....---._.._._.. . " 'Distance to nearest: Well .....2.50.... ...............Foundation .7e?: i...... Prop. Line ..., ��.. ... " . REPAIR/ADDITION iPrev. Sanitation Permit# ............... ........ .. ... Date ...................................4 Septic Tarek {Specify Requirements)..._:...................... ..:. . • ..............................:.,....:,........._...... ............................_l� ........ ..... ........... Dis osat Field ISpecify Requirements) ._.... ,�,. ...... -t.:....: -,�� .. .. ... . --clL�.-�..--...�. .�--. ..-'11/...... .�_. .��d'.41Y.�...... .Z7..i.r?.. °. G... ..........`. (Draw existing and required addition on reverse side) 1 hereby certify that 1 have prepared,this application and that the work will be doe acco once u n County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Hocilth District. Home owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work far'which this permit is issued, 1 shall not employ any person 1n such manner t as to become subject to Workman's Compensation laws of California." Signed _ _ -re7....................................... Owner By _......----•--------------•------------.... ....... ....................... Title Of other than owner) 1 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .. . ..... ......... ........................... = DATE..--... .. -- ---- BUILDING PERMIT ISSUED ----------------------------------- --DATE ....___-_-___-_._____.__. _ . ADDITIONAL COMMENTS ------- ------------- ---- - - ---- ---- -- .....---------------------•-•-••- .-_._ C-�------�s---------I--•-•-------- -----....•---------_....__ ........__... vv ................................ .. Final Inspection#� .. ... .......... . Date - ....... p y. •..........................................I, AQQUIN .. _.... . f -t ...... ... EH 13 2h 1-68 116v. 5M SAN LOCAL HEAL, "H DISTRICT 8/711 3M