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FOR OFFICE USE: • APPLICATION FOR. SANITATION PERMIT r r� ------ --- --------------------------------- -------- Permit No. ^- - - ----- --- ------------------------------------------ 4 r (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 existingRulesand Regulations: JOB ADDRESS/LOCATION .-- ----------- Gid= - �----- -----Z--M-r-----lY6r-- T-__ l/ CCCENS.US ?RACY ------ Owner's Name ._- /� ----- ---------------------------------------- ------- Address �d S Address--- � . h�0 _ - Crcen / -! -� ; _ `--'�'" _ ---- z 1*2 Contractor's Name ----- L # zy1�'/ w Phone -191- will serve: Residence Apartment House, E_ Commercial :❑Trailer Court ;❑ Motel F1 Other ----------- I I =------------------------------ -- Number of livingunits:�'``�______ Number of bedrooms Z_1___i0 �bage Grinder lV __ Lot Size ___� ©Q II - ' - ---- Water Supply: Public System ond'name ------------------------------------------- -------------------------------------t •---•-------- ---Private ger. Character of soil to a depth of 3 feet:; Sand'[] Silt ,` Clay,E] Peat❑ Sandy Loam a Cldy Loam ' 'L _ =1, H-. rdpan.❑ Adobe:❑ a - Fil-l-Material JttAAff A- --1f yes, type ------------------- --------.- --.- - -- �., {Plot plan, showing size of lot, location of system ,in relation'to wells, buildings, etc, must be placed on reverse side.} �. NEW INSTALLATION: (No septic tank or seepage pit permitted,,if'public sewer`is'availpble within 200 feet,) ` PACKAGE TREATMENT ( ] SEPTIC TANK'[ ] Siie_#_?__J_�= ----------Z `--;__ Liquid Depth --- a--____•--______ ' � �"..��'' Ca acit -?'00 f Type Material-_AN-44----�o. Compartments ___�--__:____- P Y ---- YP �---- -- -- - � P Distance to.,ne�est: Well ___________ cT-`�--�'-A---��. _,...�Found,ation ----��--C?------ --- Prop. Line -----*�----�.------- h LEACHING LINE [_].- .Na.--of'Li es --- � .-- ---- Length of`each line.... 1"otal Length ,____ ---- �� f 4. ii ' 'D' Box��-_ Type Filter Material �___J'___ - - _ __ `'i Fifter'Mafieriak _---I��--------------------•---•------- 1 t, YP �- _,SFoundat anPth{ Q-�'-'-- --�Property Line ---- ---------------- �:d , ; SEEPAGE PIT Depth ce to nearest- almeter________________ Number . -----------------71 Rock Filled Yes ❑ No Cl Distance to nearest: Well --------------------------------------- --Rack.Siz'e _____-� ------------------ � � Water Table Depth ------------------------------------------ l ouncfatron ---------=.---------- Prop.'Line -----=----------- - N(Prev. Sanitation Permit # -------------------------------'-- Date =-`-� -----==--------------- Septic --------------} REPAIRfADDITlO I i��*.�,:��-:I•� -�c! .�� > E 1 �� Setic Tank (Specify Requirements) ----: ----vi"- - -----------€ ------- ---:;----� r P P Y q Disposal Field (Specify Requirements) -------- ---------- P L - 1" ------- - �"f�_P!'f------; +-t =------- U .. - 3 F '` �_ ��e-�----- F- FCltttfi--------------------- -- 1 r�70_V--------------fbW�tt! -t -------- :_,.:, _,: ------- ---------------------_w__. - ' --- --- ----------------------------------------------------------- (Draw existing and required additibn_on reArse side) I hereby certify that I have prepared this application and that.the work--wilItth one in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: } # a "I certify that in the performance of the work for which this permit is.issued, b4he1.11 not employ any person in such manner as to become-subje t to orkman's Compensation laws of California." r Signed � � - Owner BY ----------------------------- - ----------- ------------------------------------------------ Title --------•------- ---- - ----- (If other than owner) FOR DEPARTMENT USE -ONLY f - -- - - -- . �- ----- r BUILD'NGOERMITCESSUDDBY-- {= =---- - -- -- --------- ---------= D�4TE- = _- " ADDITIONALCOMMENTS -------------------------------------=t ------ -------------------------------------------------------- -- ________________________________ .-y_-.. ___ __ _ __ _ ____-___________ _ --.-.___. __ _______ - --------------------------------------- ----------- _ _ _---------- ---- -- -- � ro ;`---------------- - - - -------- �-.----- r ectFinal Insp SAN JOAQUIN LOCAL HEALTH DISTRICT ` E. H. 9 1-`68 Rev. 5M