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VUR OFFICE USE: "}�"^� A. " APPLICATION ----- ------------------- FOR SANITATION PERMIT --------------------------------------- �- (Complete in Triplicate} --------------------------------------- I Permit No. This permit Expires i Year From Date Issued Application is herebyq Date Issued n J _----_/ _� described. This appl cationeisomadeain compliance l Heith Health District trice for o a ' permit to construct and install the work JOB ADDRESS/LOCATION .---�_ 6 g so nee No. 549 and existing Rules and Regulations:rein Owner's Name ---- "-_- �`--- ---------- vCa CENSUS TRACT Address r --u-c.------ ---- - ------Phone.-._ Contractor's Name ----------- �� -- Cit ---.-•-- --- --- ••- ---- _ Y -- -- -mac' ---�---------- ------�-- ----- --- -- installation will serve: - - - License # - '_', --------------- Residence p ❑ Commercial:❑Trailer C ---------- Phone --_._-- ❑Apartment House° ----------_"""._._ ----- Motel Court ;� Number of living units:------ -'. ❑Other "( "1 ��a�----" ----- ` Number of bedrooms -_"-"-_ Water Supply: Public System and name.--_- " dge Grinder --- -" -- tot Size- _ _ _ Character of sto a depth of 3 feet: --------------------- oil " Sand' -------=-__ = _ ❑ Silt[] Cla - --_-------_=•=--- --- ---Pr-ivate-Private_ - ❑ Peat❑ Sandy Loam Hardpan ❑ Adobe ❑ CIaY Loam ❑ Fil!Material ------ "-"- 1 f Yes, type ---- fPlot plan, showing �eof lot, location of system in relation to wells, buildiNEW INSTALLATION; septic tank or seepage buildings, etc. must be placed on reverse side PACKAGE TREATMENT pit permitted if public sewer is available within 200 feet,) } f 1 SEPTIC TANK fer- 1 T Size--"- ------------ 07 -_ — - Liquid Depth `- f Capacity --r.�b_ 2{--- nn �" --- -•- --- --- " � Ype i�Lh•a� Material - Distance to nearest; Well ___"- _ ` . No. Compartments �- LEACHING LINE �0 Foundation --___ _ - -------- LEACHING of Lines ------ ! 0---------- Prop. Line ___-- M ' -------------- Length of each line- `�� --•----- A D' Box - ' � Type Filter Material __-- ---------- Total Length __$D� -C-".Depth Filter Material Distance to nearest: Well--_ _ ' SEEPAGE PIT �� =_ Founddtiori — � f ) Depth ------ Property Line i - --- --- --- --- -- Diameter ' ---------------- Number --------- Water Table Depth ---- Rock Filled yes ❑ No Distance to nearest: WellRock Size ---"--------- ------------------ REPAIR/ADDITION(Prev. Sanitation Permit# _______•-- "`'" 'Foundation - Prop. Line "". "._ Septic Tank (Specify ------............................ - --- --- --- - -- ---- Date --------- Y equirements --------------•------•---) Disposal Field (SpecifyRequirements) -- --------------- ----- -- ----------- Y certify ------------------------- - - -� . . I hereb certi that 1 have prepare raw existing and required addition on reverse side) ------------ - -- --------------------------------------- County Ordinances, d this application and that the work will be done in State Laws, and Rules and Regulations of the San Joaquin Local Health'District. sed agents signature certifies the following; accordance with San Joaquin "l certify that in the performance of'the work for which this Home owner or licen- .� as to he me sub' t to rkma 's Compensation laws of California.,�ssued� 1 shall not employ an Signed P P Y Y person in such manner' B i ----------------------- _ Owner Y (If other than owner---- --------------- Title l ------------ FOR DEPARTMENT USE ONL -.-.---------.-.-.........-.-.-.-.- APPLICATION ACCEPTED BY BUILDING PERMIT ISSUED --- -- -------------------------------------- .ADDITIONAL COMMENTS - /VE�4i_- - _ - -- --------- DATE -//-G PTIGyrs --------- ------ ----- ------ 7€t�__ iyn""�llz ---------DATE ---------- -------------- --------------------------- -------------- ------------------------------------------------------------------------------------------------------------------------- ------------=--------------------------- Final inspection b ; " - Y° -- --.-.-.-.-.-.-.-.-.-.-.-------------------- ------------- SAN JOAQUiN LOCAL ----------- ------.Date ---- -- H H DISTRICT tom- lC� " 1 F. H. 9 i-'68 Rev. 5M -- �.