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r- r , fi-... _..FOR OFFICE APPLICATION FOR SANITATION PERMIT ,,/-,�� ..... .... ..__..___ ... Permit No fCemplete In Triplicate) ......... ............. . ... ... . .. .......... pp 66 .... This Permit Expires 1 Year From Date(resod Date Issued Application is hereby mode to the San Joaquin Local Health District far a permit to construct and Install the work heroin - described.This applkation is made In compliance with County Ordinance No. 549 and existing Rules and Requlotionst JOB ADDRESS/LOCATION CENSUS TRACT ..........I............... Owner's is-cat ./L.r.....1 T1.c ........................ .... ......., ... .. ........ ... Phone .�F.'d'..4.`�—T....... Address _. . :S i f/....... Jp t[✓71111 l—P91...B�C../?>......_City ..:�9TyC.d ... .............................. Controttci's Name . ... . .._. . __.-_. . . ........ . ... .. ................ .. . :...License .. phone. lr.(.1'f!G .. Instolkstion will serve, Residence 0 Apartment Housito Commercial ❑Trailer Court ❑ Motsl❑Cnher . ..... . .. .............. ... ..... 14 Number of C living veHsx.. �.._... Number of bedrooms .,......Garbage Grinder ......... Lot Size ... � ............... .... Svpply: Public System and name ......,/.e.2N,C P....iu.4-71�.C. . ............ ......Private❑ Charatlw of soil too depth of 3 feet: Sand o Silt❑ Clay ❑ Peat❑ Sandy Loam,$ Uay Loam❑ p Hardpan❑ Adobe❑ Fill Material If yes,type. Y f• IHall plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse ski. '.NlMf MYALLATWN: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT ( ) SEPTICTANK{ ) Sisa. ..................................._.,._.... Liquid Depth ..........................� } Capacity .._._...... Type .. .. .... .... ... Material........ . . No. Comportmenh N ' iDistance to nearest, Well _ ... .........................Foundation ............... Prop.Line ..... ... J _ 9 LEACHING UNE [ ] Nb. of Lines .. .. . . Length of each line ..._ ...I .— ...... Total length ..... ....... . � r 'D' Box __. . Type Filter Material .... ....... Depth Filter Material pDistance to nearest: Well .. . . ... ........... Foundation _. . -...... Property tine-. ... ................. , SEEPAGE PIT ( J Depth .. Diameter ............. . Number ... Rock filled Yes 0No Q Water Table Depth ......... .. . .............................Rock Site .................... c Distance to nearest:Well ........................................Foundation _.......... ....... Prop. Line .... ....... ' . ROAR/ADDITION(Prev. Sanitation Permit# .._..__ ... ...... . ._.................. . Date .................................. pI Septic Tank (Specify Requirements) ..it. .......... ................._...............,...__................ Disposal Field (Specify Requirements) _ ............ .._...... : , ......._.........__.__.._. ...._........_ ._� . ... .._._..._... ...__..................................... .........__ ........ ........... .._. .................................... _._ . ....... .... ... .... ...... .. ... ... _... __ .. (Draw existing and required addition on reverse side( 1 hereby certifythat I bow prepnmd this application and that the work will be done In accordance with San Jacquie - Cess" Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District.Home owner or Ikon► sad etpente signature certifee the following: "1 tarNfy that in the Wornwnco of the work for which this permit Is Issued, 1 shall not employ any person In such manner as M became,sub( n' mpensotion laws of Colifemia." iSigned . . Q ... ._. ............._...................... Owner 'i BY. . ..._... _......... ..._.._ _..__... Title _ . .._..__. ... Of other than owner) FOR DE ARTMENT USE ONLY APPLICATION ACCEPTED BY ._ t_... '. 6->'- U? ..- _. .. ... __.. DATE . !- BUILDING: PERMIT ISSUED .. .. .. . . . .. ...... . ... _. . -- __ .. .. .DATE . .. _.. . ..._ !i ADDITKJNAL COMMENTS . ..... .. _.. ..-.... .._.......... ........... _. ... . . . .. _. _. .. ............ . ....-. . ........... �� .... ..... ....._. . . .__.. _ ._ ........................................... . . .. _. . .. .. .. .. .. .. _. .. ....................................... p- fimillmpection by:S�� .. ...... _. . . ... .. ._... . ....Dat@ ....9 .. .Q.'.7 .......... SAN JOAQUIN LOCAL HEALTH DISTRICT ,E,H.13 241•'68 Rev. SM 7/72 3 H _)