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FOR OFFIC SE: /f APPLICATION FOR SANITATION PERMIT ----�-5- -------------� Permit No. (Complete in Triplicate) -- ------------------------------------------- ' - --------------------------------------______________ This.Permit Expires 1 Year From Date Issued Date Issued ..�._f. ._ r 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 Regulations: rE f�It�JOB AIDDRESS/�LOC�ATION , 77 - �/� �Sf4s�c - t` CENSUS TRACT Owner's Name ------ llllljP jyIfveC�,r 4-P. ' ------- -------------- -------Phone._ _----- 5 45 Address3 ,�� eYeS-- /.�.C�=-- �F'yl----------_. City --------------------------------------------•--- --------•------------•---•- Contractor's Name ___<YGL/!1 e------------------------------------------------------•-'-------License-# �� .; �j------ Phone -----------------_-•-------- Installation will serve: Residence ❑Apartment House❑ Commercial t:❑Trailer Court Motel ❑ Other "_ , -- - - - - - -------------- Number of living units----- _-_ Number of bedrooms _�� r1-MP �', ___ _/-/"__Garbage Grinder -.I-- Lot Size "___._______ _ -----__ _ _ Water Supply: Public System and name "l�/ i1 l kr�-' __70 r-14... ...!^__. Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt "" p ❑ .- Clay..[:] Peat`( Sandy Loam ❑ Clay Loam ❑ � Hardpan EJ) Adobe' Fiil'Material_t,10--_ If yes,type ---------------------------- (Plot __- "---___"_-__________(Plot plan, showing size of lot, location of system in relation to'wells,:.buildings, etc. must be placed on reverse side.) kl) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,} A,s_X D__Ld17 -____" Liquid Depth ____ _._ PACKAGE TREATMENT X SEPTIC TANK [ ] Size_.r ---------- F . Capacity A&I"—s Type : '____-____ ___ Material"" .�' _- No. Compartments Distance to nearest: Well --------Foundation _�� .�_____ Prop. Line I .: � Length LEACHING LINE � No. of Lines __._.__[___ ____________ Length of each line`------ Total r I D "� t Q' Box ._.. ._ Type Filter Mate�iahl-TZ�C1�-C&epth Filter Material ------le.______.__.__- Distance to nearest: Well .__34 l'£__,_ Foundation M_ `-f------- Property Line SEEPAGE PIT [ ] Depth ---------------" --- Diameter -------------.-- Number ---------------------------- Rock Filled Yes`[:] No C] 1 Water Table Depth __- ---------------------- ' _ Rock Size ------ ------------------------- :: a Distance to nearest: Well _"."""___`________w"-___.___--r_=r__"Foundation __ ______________ Prop. Lined _ ti REPAIR/ADDITION(Prev. Sanitation Permit# ------- ----------------`.------ ----{:Dat'e _.--------------------------------} e) a, Septic Tank (Specify Requirements) --------------- _ ------------------f'�- ------------ ------------- ----------------------- ---------------- - Disposal Field (Specify Requirements) ----------- ------- ------------------r---------- =-------- � ----------------------•---•----------- ` =------, ------ -------------------------------------- ----- - 1 hereby certify that I have prepared this a fstl caliott and 1thatath""�'�_-"--- :"-"-"- -" """"" Tdaition on reverse side} Y fY P P pR et work will be done in accordance with San Joaquin ..3 County Ordinances, State Laws, and-Rules,and Regulaitiens of the.Sa Joaquin 44cal Health District: Home owner or licen- sed agents signature certifies the foilo ing: � 0ti "I certify that in the performance of the work for-vihicFt'th�s.permit'is �ssued,`1 all ot"employ'4 person;In such manner as to become subject to Workman's Compensation laws of California." ;. M .� Signed _ "" --:""-�"` ------ Owner _I By ------------------------------ +' �.,�., ---------------- ' - Title (if her owner ------- --- - ---------- ----------------------------- - - p-FOR.DEPARTMENT-USE ONLY ` .0 APPLICATION ACCEPTED BY ---------------- -- -__ &1-1h _ COO, BUILDING DATE-_ ---� G ------------- BUILDING PERMIT ISSUED _-- + DATE``' __ ADDITIONAL COMMENTS �� °! " I_.. �1�/r7..-., n�'' - - - ----- _ .._. �-- / _ -r --- -------------- --- „ s i. ------------------ -" --------------------------------------- -------�- --�-- - _----------- -------------- - - ------------------------------ Final Inspection by --- = --- p Date q ------ SAN-JOAQUIN- LOCAL�HEALTHiDISTRICT E. H. 9 1-'6i3 Rev. 5M