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FOR OFFICE'-USE: r APPLICATION FOR SANITATION PERMIT' ---------------------- ------------•----------------- -- Pe mit No. --------- . (Complete in Triplicate} =-------- _ _ - -- --- -- - `---- -I J' Ddte Issued -?� ____._._._ _ _____ This Permit Expires 1 Year From Dat", sued � 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 Rule's and Regulations: , � uQ JOB ADDRESS/LOGATILN��.-^M1 ppg987-----_�------- _�. - -- --------_---------CENSUS TRACT -- ---_j/--'---- Owner's Name _R/VB_3_E-----------NORA----------------------- -> i Phone Address8V9.I ,------------ UER-E_�-------------------- --- City j--------------------------- -------- ------------------- ....... Contractor's NameBwr+€�-------------------------------------------------------------- -------Licens4 # -------- - ------------ Phone ------------------•--••-•----- Installation will serve: Residence ❑ Apartment House❑ Commercial ❑Trailer Court ❑ Motel ❑ Other,,__.------------- I Number of living units-----/�----- Number of bedrooms ----- Grinder .A'_d--- Lot Size./17FGR /�14_�_ ___�_ . Water Supply: Public SystemIand name t'-------------------I -------------=--------Private Character of soil to a depth lof 3 feet: Sand'❑ Silt❑ Clay ❑]Pea(❑ d Sand�m lay,Loom ❑ Hardpan ❑ Adobe ❑ Fill h to erial. If y ,type + !�.__ es e - - \- i t1 (Pl'ot plan, showing size of lot, location of system in relation tolwells, buildings;,.etc. must be placed on reverse side.) G NEW INSTALLATION: (No`�.septic tank-or seepage_pi •permitted i""blic sewer is avails le within 200 feet,] PACKAGE TREATMENT [ ] I SEPTIC TANK'[ ] Size--------------------------------------- -- ---- Liquid Depth --------------- CaacitY Type € Ma#oris! Y lo. Compartments ------ --------------- Distance to nearest: Well _--iength-of - `__-`�""' ------ Prop. Line ----.-- __------- • - —------ - -g -- -- --- LEACHING LINE ['] No. of Lines ---------------------- eachy,line-_ Total Length ._-.-----------------•-_-.--- D' 1Box ----- ------ Type Filter- aterialA=te_-.ti-------------Depth Filter M erial --------------------.----------------------- YP -' , Distance to-nearest. Well ----- ------------------ Foundation -----------------} ---- PropertLine ---------------.--.:---- SEEPAGE PIT [ ] Depth ------ -:-- _ -- Didmef `---- '-- --=- Number--`----'s�---- #- Rork .EilEed Yes ❑ No Table Depth ------------ ---------------------------------Rock Size ------ '__----------------- Water _ry 1 - Distance to nearest: Well _____ ______-_____-'___________________Foundation ___ ------- Prap:' Line --------------- REPAIR/ADDITION(Prev. Sanitation Permit r# -------•-------------------------------------Date'_-----------------]------------- �l } y ) � Septic Tank (Specify Requirements) . } _�Q -- --3 1 1iF1 -----�A�D-------�1g 9--- ----- Q i CIS------( tTfj• i Disposal Field (Specify Requirements) /;W0--aAL-___PR15:7F }[3---{-�1VC_RETIE—___- -------_------ 1Q-Q-._ OF.. LEA-CH- L1AfE ------------------ --------- - ----- X- X 5 --------- ---------------------- �� - -_:-�_: .- ---------------------------------------------------t_t------------= ----------------------------------- ..� (Draw existing and required addifion on'reverse side) I hereby certify that i havel prepared this application and that the work will be done;in accordance with San Joaquin County Ordinances,!State t:dws, and Rules and Regulations of the. San Joaquin Local Hedlth District. Home owner or !icon- sed agents signature certifies)the following: "I cerci at in the perFornlance of the work for which this permit is issued, t shall not employ any person in such manner as to be a subject to V1d&man'e5rpensati.on laws of California." Signeg - - -- - - �-------�-- ----- ------ ---- ------ ------------ .--- Owner --IN € - (If other than owner) + p. ^ i r �k FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -`------------------------ -------- --------------------------------------- DATE ---(- k BUILDING PERM•I-T- ISSUED _ --__ -- - - _ --_ = DATE,.__ ---- ADDITIONAL COMMENTS .-!M__.___-------------------------__-_ --- - -- j,- = = == ' ] } ' f -.._..------ -•- . ---- -:- ----�- _- - - ------- ------------ -- _ ..i _ ----- --------------- ------------------------------------------ = ""------- - ---- ---- ---- - --- ------------------------------------------------ ------- --- - Final Inspection by: J ' --------- Date _ -- ---- � ----------- SAN -- - SAN JOAQ N LOCAL HEALTH DISTRICT E. H. 9 1-'66 Rev. 5M.