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fi FOR OFFICE USE. APPLICATION FOR SANITATION PERMIT f / Permit No.6#Z : .!461:?, '`" (Complete In Triplicate) .............................................. Date Issueda/u._� -./�.% - This Pe rmit.Expires i-Year From Date Issued 4 ! 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: (So. of Ni a 50) JOB ADDRESS/LOCATION�C.206+3'_.So�.._Hata..Ewa.s.....TZI.Q .................I........C1:N5US TRACT .._... ............... x Owner's Name .. ... .....$._.f.-. 9T.LEy...............................:......_..._................_..__._........ Phone ...835- 4349..... . .-...... Address Ss r..xQu e...slut.h.._Q '...Ira- lex...house.............City .....TracY.......................................... ....:�:.....__ Contractor's Name ...... l�, '1QUIS ......:.......Lice # .9.9594...__..... Phone ....$3Jr�3�,V4.._.. k Installation will serve: Residence®Apartment House❑ Commercial []Trailer Court fl Motel❑Other........................................... l .. _..... a. .:. Number.of living units,............ Number of bedrooms ,....2..:.Garbage Grinder .._-........ Lot Size _.ACprB�B.........:.-. Water.Supply. Public System and name "' Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay C] Peat❑ Sandy Loam o Clay-Loam L[j Hardpan❑ Adobe 3XFill Material If yes,type ••-- ;(Plot pI h,.showing size of lot, location of system in relation to wells, buildings, etc. must be.placed.,a reverse.islae.) ).3 :. { NEVI►INSTALLATION: (No septic tank or seepage pit permitted If public sewer is available within 240 feet 1 � F: PACKAGE TREATMENT [ ] SEPTIC TANK{ ] Size................................................ Liquid Depth . ks'' ......... .............. Material__ ..... No. Compartments Type ...... i Line t ...... rest: Well ....................................Foundation......_....._......... Prop.to nea Len-'ti of each line........................._:: Total Length..:. . , ...............• LEACHING LINE ( ] No. of Lines ..................... y.. 'D' Box ._-......... Type Filter Material ................... Depth ^� .._.............._. _ Filter Material ' Distance to nearest: Well ........................ Foundoti n ..................... Property Lina <r SEEPAGE PET. [;J �ef��h�•................... Diameter ................ Number __.__....... ........... Filled - Yes © .. Ido;Q. -^---- Wdfer�'Fable Depth .....................................�.'_�_R ck 51z ;: ___....... ............ WWer. ... -151 + �vn ion ....... ........ Prop Llnsstancef�nearest.- Well ..............._._._........._..�._... chat i � j REPAIR/ADDITION(Prev,Sanitation tPgrmit.d�.....................................i.. Ptic'.Tartk,l5pecify Reauirert�hts�'." .#"::�aC.j.S�r [l$:..::......:i--�-t T... .........V�-. � { .. 13 _ ._ Ufa Disposol Field IS pecifyvRequirerrikntsl ......._. IIS &a. 7Jg...�}�...a�A•• *. 1Ftt Fid -Sl�pl-@�Bi1 lT�`gni ........ ... ...... leachiia dxain r� ox .... i 8 ._�-.._>I.. ... i f ,L, f ...... ---•••-- .................................:....•...........-••............I...__.._......._. ...........................................,.. jDrow existing and required addition on reverse side) 4 .I,hereby certify that t have preparei this application and that the work will be dons In'cttordance with San`Jooquin «; �,:s_,•, ; County,Ordinances, Stats laws, and Rules and Regulations of the San Joaquin Lacal.Health District.Home owner`er Ilton- � agents.slgnatnid certifies the following: 1 .'.:.. "I certify that in the perf ce of the work for which this permit is issued, I shall not employ anypersen in such m6nner as to become sub)ect to ark an's Compen laws of California:" 3 P�7JUIS"r PTS SE CE �- ..Signed .:... ....-_ ... Tide ..Managq .- ........ w By: (tf other tho owner) _ '' F _•.: F R DEPARTMENT S ONLY 5 • v w+ �Y f ... ........._•..... .. ...... APPLICATION ACCEPTED BY.......................................... ......... DATE. I � :.. ::. BUILDING PERMIT ISSUED........:.:..:..... ...... DATE_..............._.................:....... ...••..•................. ADDITIONAL COMMENTS ......... ..... ..................................-.:--........................... ............. ........................ .................................................. ........._......._..........._.._.. ...__...... .._... .,nal Inspection by .. .............•.....-_.:_......_............-_....._.._..... .. *LRICT M....._....Date ...L :p�C � } .}..._.._ SAN JOAQUi L AL HE { t ? N E. H. 9 W68 Rev. 5M.% al rat,,.w.,« -^ '�ws�i+•� ...,._.....—.t .� .- --. �...... ... - - -