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1 P" FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. . ...... ...._............ ......... ... _ - ._..._. ._I This Permit Expires I Year From Date Issued Date Issued ") -4- Application is hereby made to the San Jooyu:n Local Health District fof a permit to construct and �instoll the work herein described.This application is made in compliance with County Ordinance No. S49 and existing Rules and Regulations: , + JOB ADDRESSA .,,_`�f.•L>7 Gwry,(,{ c JON��/7I/- _ ,� �.. . CENSUS TRACT ... . . . ... Owner's Name<�F �=rc��_Z... ��/ � .c .r.. . .. . .. . _ ... ... ......Mome 1 /-0 .37J_ Address , 577 NOY C. Contractor's Name License i 2S-31/7j..-. Phone -�7le<g Installation will serve, Residence[]Apartment House C] Commerclol Xratler Court C] a c�-�.,es Morel ❑Orher ......._. ..._........................ .. Number of living units: _..._ . . Number nF bedroom ____Garbage Grinder .. Lot Size .., ....... Water Supply: Public System and name _.._. .._._.. ...._...__. ....... _......_. ......._... ..._.__... PrlvaM� Chic ratter of coil to a depth of 3 feel) ,,and 0 Silt C] Clay ❑ Peat C] Sandy Loam C] Clay nr' 1 7 i Hardpan[] Adobe Fill Material _._ If yes, ty,a .. . . _.. . . Y4 ,.y. (Plot plan, showing size of lot, location of systcn in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: Wo septic tank or ceepago pit permitted If public sewer is available w-it l 400 feet,) PACKAGE TREATMENT [ J SEPTIC TAK6Ize �sUavid Depth CapacityrIoRQTyp.VW. S50 .Material.X /... No. Compartments ... ...... Distbnce to nearest: Well CY ._'..................Foundation .. ... Prop. Lin: ..' �� LEACHING LINE No. or ones length of ouch line....... C......_. .. Total length yQ................ 4 : i 'D' Box ...... ._ Type Filter Material r.�>,!!a .' L .Depth Filter Material .. �B._._. ......,......._...... g *} Distance to�nearest: Vi'ell�p2) . Foundation Q.,�......... Property line ,7 SEEPAGE PIT X Depth .pC,s . . . Diameter i .,�... Number ._. .... Rock Filled YesX No 0 s o {r , Water Table Depth __ a Q. .,; ....Rock Size . X ........... T r Distance to nearest: \Nell �sa . .....FoundoticProp. Ileo REPAIR/ADDITION(Prov. Sgnitotion Permit# ... .... . - ? Date------------------ Y Septic Tdrkt (10ecify Requirements) ._ ...._... .- ........ .. ._.__.. . ._ ... Disposal Field (Specify Requirements) .. ........ _. .. . _ ... ....... .......... .. .._.. ._ .. . .'............................ . . ................. .. _ . .. ... . .... . ..._ __ __. _ ...... .._._. ......... ..... ..... .. _. . .. . ..... . .._ . . .._. ...._ 7 (Draw existing and required addition on reverse side) k 1 hereby eMify that 1 have prepared this appll:alien and that the work will be done in accordance with San Joaquin �4 County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Loral Health District Home owner or IIcen- sed agents signature certifles the following: "I certify at in the perlorme of the work for which this permit is Issued, 1 shall not employ ow, person in such manner �- as to Is 406 s tir 10 rk 's Cc en lawn of California." 7 Signed .::Owner .... i . ._.. .. '. ' By .. . ..... .__ Jitle ...... .. . _.. . .. (I` f outer than o .... . .. F�OR DEPARTMENT USB ONLY _ APPLICATION ACCEPTED BY Y - .• ..Y�{V^"�. ... .��w"_ ....... DATE .. C. .y BUILDING PERMIT ISSUED DATE . ...... ADDITIONAL COMMENTS _.. . . .... ........ . .. . _... ............... .... ,i rfinalins pectionby.,.. fYltfe... . ....._ t.,pu, .. _ !+ ._.. U '-rte''. .. . . ...r. . ... .. ._. .Dote "s -- '- SAN JOAQUIN LOCAL HEALTH DISTRICT r. W 9 1-'68 Rev. SM ;fin KiK'umW Nr-:2r.': •y^.x�.