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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ------- ---- ---------- (Complete in Triplicate) Permit No. ---------------------------------------------------------- _--___---- This Permit Expires '! Year From Date Issued 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 Regulations: JOB ADDRESS/LOCATION .--- - -_/-J�----, ----R-1- - --- ---------M.SC--------CENSUS TRACT _S__.117 Name ---------- -R7---------Tb><)--I, 4� t`ti� y:� --------------------------------------------Phone ------------------------------------ Address -73 --------� }_ 5.QIV_. T- 1•,� -.,... City --------- -------- Contractor's Contractor's NameCHS gBE_PI+�A7__ --------- ---.License # Z2.7 31 -'Phone ------------------------------ LJ -- Installation will serve: Residence . partment House[0�ommercial ❑Trailer Court ;❑ a�6A Akotel fl+'Qtf$er ---------------'� - _-------------------- Number of living units:___ ------ NvrPFb;e.W bedrooms __ ------Ghrbage Grinder$--- Lot Size p+ &Z-------------_ Water Supply: Public System and name ------------------------------------__1--------- ---------------------------------------------- ----- Private 9�_� Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam R<1 GlayhLy am ❑ .� Hardpan e 1 AdE]obe Fill':Material _1V0--- If yes,type -_r ______---- . r [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,publie sewer is available within 200 feet,) .� PACKAGE TREATMENT [ ] SEPTIC TANK')- Size.__�YA147_._x'5_-------------------- Liquid;Depth ---- Capacity ___Ca aci 2 ©Q Type PftE-f'�q terialF�d[M-__ o. Compartments ---______________ � Distance to nearest: Welly _. t . r Prop. Line LEACHING LINE [/r No. of Lines ------_L------,. Length of!'each line----100------------- Total Length ----- __r_.._.__ , p (c '11 'D' Boxyi-s-- Type Filter Material --)?OCK---Depth Filterr Material _____1cr-------------- _�______-..-..__ Distance to nearest: Well Q_c_ j_ Foundation-_____fQ.__"� Property Line -4- Distance F- _______ ___ __________________ SEEPAGE PIT [� Depth lL r �.__________ Diameter ,___X_ ' Num er __ .__ --_______-�_ R k Filled Yes j�No i❑ Water Table Depth -----7-Q::_'-_-__ " knock Size/� A 4 1 n 'i n _r - �y a il. V Distance to nearest: Well --_ 00------ ...Fou dat o '� _____' "t _ -_. �-•-- i. .—.-_ � a REPAIR/ADDITION(Prev. Sanitation Permit# _____________________ ___-- <- Date ____ _ :_ ________________) ,...��. Septic Tank (Specify Requirements -- n ' i " Disposal Field (Specify'Regrjiirerments) -----14-F-dO9 _____ (_tY - ---------36-________WVW----_.-- ______ ------------ - --------------------------------------- ------------------ ----------------- -=- -- ---- ,--------------- -)------------------------ [Draw-exist-- and re ---red adw--- W------------------------ ------ --- --------------------------------------- di#ion�;on reverse side) I hereby certify that I have prepared this application.and t4t' the,.-work will be done in accordance with San Joaquin County Ordinances, State Laws,land Rules and Regulations #_the San Joaquin Local Health District. Home owner or licen- sed agents signa ure certifies the following: "I certify t 'at ' the&perFrnte of the rk for which this.p�erfmssis issued;-),shall not employ ar�y person in such manner as to b ubjemc�n's Co ensat'uon laws of Cbli(8rnjaY�4? Signe .- 17 ----- --- - ------ ---+�--------------------------------- Own ' i By ----- - ---------------------------- a --- --------- Title -.- w (If other than oner)oe A"V14 % Ut C FOR DEPARTMENT -ONLY " APPLICATION ACCEPTED B'Y^_,-----�i-R46----------------------------------------------------------------------- DATE --- BUILDING _BUILDING PERMIT ISSUED ----- __ -- - --- --- - --------------------------------------------------DAT - - ------ ----- - ADDITIONAL COMMENTS ----- �=«�� /4 ©lr u�l.F-Tt-f_-,CQN (Z ' `l_1 - -- -------------------------------------- - ----- -------------kN --------- ------------------------------------- -- ---------------------------------------------------------------- ---- ------------------------------------- -------------------- .: �----------------------------------------- -------- Final Inspection by: Date ` LOCAL--HEALTH—DISTRICT E. H. 9 1-'68 Rev. 5M 1J'ER}lXCIPTf pn/� �Q t