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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT„_. . r'?ttenpkfe _......:...._. in Triplicate; Permit No. •••• : .... ..... This Perehtt Ezpins 1 Year Poem Date lssuid Date Issued pplication is hereby mode to the San Joaquin Local Health District for a permit to construct and Install the work herein described. This application is_inadyye In compliance withCounty Ordinance No. 549 and existing Rules and RegulaHx on JOB ADDRESS/LOCATION .. A..`.S'l_. 4....L ..!Lf/...- .� ..y....... ! Q¢+-1----.......CENSUS TRACT .........._.............. . f Owner's Name .................f'Yl.:....... 07(r-.- Phone A-9,2.. - .......--... �1......__.......city _...... _ Address .............!-.4 ��5.'.... .f. . ..]- .....,'....... .... .. .... Contractor's Name ................ G l-. _.. .. .�t!1.....-.:.:........Llosnse#,L .. ; 3. 3.. Phone y -�d 7». _ ....__--- installation will serve: Residence 14 Apartment House C1 Commercial QTrafier Court 0 Motel Q Other..........-------------------------------- .....::.. -... Number of living•uruts::._-'/.... Number of bedrooms'.._ Garb 1, 14 / age Grinder Lot size ...0 .... -d-__�r_.�....r......... Water Supply: Public System and name ............:............. ° ..................... y�a(( ........._----._._............................._..-_-__.. Sa .Character-of-soil to a depth of 3 feet:- Sand 0 Silt C] Cloy Q peat 0 sandy loom{] Clay Loam 13 Hardpan 0 Adobe❑ Fill'Mafsrfal ............Ifes —� y ,type........................•.-. -r pt plan, showing size of lot, location of system In relation to wells�buildings, etc. must be placed on reverse ifde.) ` NEW IN TI septic.tonk.or.seepage pit permitted.if public sewer is.available within 200 feet,) {y() PACKAGE TREATMENT [ I SEPTIC TANK i ) Size__`............... --._.._....•............ Liquid Depth..._......._..._.,_.._.. �"^^ Capacity -'`�`............... Type .----- _.-._:.. ._.. Material. ------.._...:--. No. Compartments _:....__..__.._... Distance.to(nearest: Well ........... -----Foundation _^.................... Prop.Line.......... LEACHING LINE I I No. of Lines ..-------_............. Len w Length ofeach-line..-.------Y...............Totat length ......-..............._... D' Box sType Fitter Material ........... -----...Depth"filter.Material ........................... Distance Distance to nearest: Well ......... spn J , ............... Foundation t..._;...... Property Line QEPAGE PIT { I Depth Diameter ': .Number .............. Rock Filled Y4.0 Ne Water Table Depth ........ ... ... .....................Rock Size ._...... :. _ . Distance to:nearest Well ................ Foundation ...............,_,: Prop. line_ -- REPAIR/ADDITION'(Prev. Sonitaifon'permit#............... F. .......... Date .......................r._,_...._► Septic lank (spetifa+ Requirements[,...:,...:. .............._.._...._........ ..... -... -----...._.........-:_.. _._ Disposal Field (Specify Requirements) ... .� .,- �'~ } zQ ' ......... ......:...... _ 4 _ (Draw ix1sting and I her Ordinances Stora laws, and lu this Regulations of the,addition Jk will be cl flealth�Di order-.--.•-••••••---••.•-•••----clul-� C G' 1 hereby'eeAify that 1 have prepared this application and that the work will be done in,accordance with San aoaquM s r� Name owner or 11cm sed agents signature certifies file fetlowing:. ( certify that in the Performance of the work for which thisermif 4 issued 1 shall act em - ! P , employ any person in such manner as to become subject to Workman's,Compensatlen laws of California.,' Signed ............. ......c t:r^... ... .._ By .... ~ Owner \.^.. .r ..__...... .._.. ...... ._ � Title ------- r . / (lf othe n owner) _................... ........ 1 DEPARTMENT USE ONLY APPLICATION ACCEPTED 8 . ._ ... . ............ ...H...................................... GATE _.� _�lr ...�.�........:...: BUILDING PERMIT ISSUED ................................................DATE -..._...-- ....... ....... ADDITIONAL COMMENTS ..........._....... ............................................................ . .� -------- ..............:........................-........ ...08/7h .........--...............-- Iins scionb : .................... .. .. . . . . ..-....... ,.---':a-•.....�;;;.y-..........._.._...__. .. - Ilf 13 2!t . 1-fifJ Acv. __.....................:---................_......Date . >��z SAN JOAQUIN'LOCAL HEALTH DISTRICT jM F