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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -...__._.-------"--- Permit No. ........-......-.---•--• ._... (Complete in Triplicate) ......_ I..`--•••-..........____.._.............. P Dote Issued This Permit Expires t Year From Date Issued " .---..-.-•----•-----._..-..-.------...-- _ Application is hereby made to the So Joaquin Local Health District f�& a permit to construct and install the work herein gr�g,with Co my O� rdin No. 549 and existing'Rules and Regulations: described. Thi lice ion is made co li l5 �•- � fit-`"` ,et7 avtel�• - 044 WVZ,3+..CENS S TRACT _..5- � ... JOB ADDRESS/LOCATION _ - ---- �j __._.....�--•- . Owner's Name (,[ ! .._. .. :c:- - _ ..._---Phone--....._-.__..... --.----•-- Address ._ cX-��7a�2 -y�------s'°'........ .. Contractor's Name /...e�C.fi -_ ``y. --- Phone .. = •`- � •S -- FC-�!}H/ .:1 License s -- Installation will serve: �esideirce❑ApartmenttHHouseu Commercial❑Taailer Court Motel ❑:Ottier-1.'lQ /L-. ° -`r-- -- t Number of living units:_-- ...... Number of bedrooms _._—.. .Gprt)age Grinder -.. - -- Lot Size ..__1. ._�9 ..... "i� t_ r I '------•---------- Water Supply: Public System and name ---------------- --�_S. n.- _Private Character ofsoilto-a-depthof-3-feet:-•}Sander Sik❑= Clay-© ?oat-©juSandYloam_P-' i•lay'Loam-[]____:__-..___�� Hardpan❑ Adobe❑ Fill Material 7 -------- If yes,type-..---•-_------------ --- {Plot plan, showing size of lot, location of system in relation to wells, Uildings, etc. must be placed on reverse side.)(/( ) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is av liable within 200 feet,) 4 t �`l (_` ........ Liquid Depth ...._�� PACKAGE TREATMENT [ ] SEPTIC TANK T ] + Size...7.Z--�--{'X---7-�- p Compartments Capacity /�p_.._..... Type��{C�a S7_, Maferial4!!'.iMP.:��L_. No. Comport --._-Foundation /Q--------------_ Prop. Line......r� Distance to nears,: Well .-.•-�-- --- -------------- - LEACHING LINE [ J No.-of Lines Z ------_-- Length each line...... .0............. Total Length -- X ---......Depth Filter Material -----��C.-----. - 'D' Box ...�_._- Type Filter Ma»ria ._. _..-- ^_ Distance to nearest: Well ....S.R...-•---7. Foundation -- - - Property Line. .------5-._..:..- t "0031 SEEPAGE PIT [ J Depth ._._---_--------- Diame»r ____-.. Number ----------------s— Rock fills/ Yes ❑ 1 --...__-Rock glee ...E_:::............. Water Table Dept - • Distance fo nearest: Well .__..__-._...•-_-•-••-----•- Foutsdatiat ---- Prop lin .................... 1 - Date ----•-`----.-------_ ..�) REPAIR/ADDITION(Prey. Sanitation Permit# . --•y _L ...__ _« ...-._....-.._._M .............. Septic Tank (Specify Requirements) .................. . : R uirements) Disposal Field (Specify eq � .S• J'"'-'-�---•-•----------•--��- --.... 1 .........__....... Y� l `' -...-.....---.................._.. ------------------'---------------- _ . . ---- - - (Draw exxi . sti.ng. -on-d required addition on reverse aide) I hereby certify that I have prepared this application and that the work will be dose in accordance with San Joaquin County ordinances, State Laws, and Rules and Regulations of the San Joaquin LocalHealthDistrict. Home owner or licen- sedagenI signature certifies the following: ' person in such manner "I certlf �hdt in the performance of the work for which this permit is issue' d, i shall net employ arty as to berme, subject to Work n's C PonsgRolt laws California: Signed �. vim_ . Owner .. .. - 1- . (if other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY. LR C�. - ------'------- - DATE .._I-- . .L.�� . .._...... BUILDING PERMIT ISSUED ._------------------------------------...._......_....._.._._. •------.---------z___--__DAT - - _.._.. ADDITIONAL COMMENTS ..... -•--------------------•-----.............. _._.._.._.._.._ — — - _. _.._.—... ' -- _...._------------------ .. — _._...._ ....__.. ........... - �_.:_.. ...... --•-•-......__.._. ..._...-....._-.......__ . New t t -•----..Date ...X.... ... - - - Flml In on by:_. ��.:. --------- f SAN JOAQUIN LOCAL' HEALTH DISTRICT : E.H. 9 1-'68 Rev. SM.