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__. �.- �..-._- 5� dU �S w r r (}D 5 / APPLIC T10N FOR SANITATION PtRMIT FOR OFFICE USE: Permit No. •... .......... •--....... ...... (Complete in Triplicate) N --.._....... -- `� w. Date issued -.�•�•l�•"=�� This Permit Expires I Year From Date issue "Nq Application is hereby made to the San Joaquin Local Health District for 2� permit to construct and install the work herein P is made in compliance with County Ordinance�No. 549 and existing.Rules and Regulations: described. This app 'I�cation ��. ENSUS TRACT JOB ADDRESS/LOCATION ".- . ..... . . --------•..... ....... ... "� Owner's Nam ...... City -�r'�-� c.,� �_. Address .. -4" lg�v./.. ....-.. /f �gy Phone ........ - ------------------- .� , fL.=. - icense # �� ti Contractor's Name ----• = ' ' Apartment House[] Commercial j]Trailer Court. ❑ Installation will serve: Residence' ( Motel Q Other _.--• ---------- inder -.77n=Grinder Lot Size ••': ••- Number of living units:.-.r- Number of bedrooms_ _.Private ___...__.............................. ---•- Loam ❑t I Public System and name ----•-•--•-----------• Peat Q Sandy Loam ❑ Waterupp y: Clay_ Silt❑ Clay ❑ Character of soil to a depth of 3 feet: Sand 0 e --------------- .......... t Hardpan (� Adobe '[] Fill Materia{ .........._. If yes,type Olan showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) (Plot pion, 3 it permitted if public sewer is mailable within 200 feet,)1 J d IV/ NEW INSTALLATION: I (No septi tank or seepage p' p � / Liquid Depth 4--`-:- -•-•---- SEPTIC TANK T Sizee.2--14C--•-x "•--• . ' PACKAGE TREATMENT , [ ] No. Compartments ........ --•••- I © e Material. 1 1 �Capacity -j-S- --C'-----•-- Type , e Foundation ...... .-0.......... Prop. Line .-...:;....". ` .:•�( N, ;1,y^� Distance Ito nearest; We � •-••-•--- --•.... 1 ' Total Length o�.C. !.-.... = i No. of Lines .._..ar2 ..-"•- Length of each line LEACHING LINE [, 1 Type Filter Material .-__ .<<�-=----•Depth Filter Material ----�- -- 5 "" ' !'D' Box -.Mearest; YP , __ Property Line ............. ! No C Distance Well -.:__.I_oQ--•--•a._ Foundation .....1,0-1 Rock Filed Yes �] � �3 Number . ............... •, � De th a�S- — Diameter D'iameter --••••--•------• SEEPAGE?lT [�J ` p SWater Table De th Rock Size .---.------ J . —Foundation ............. ...... Prop. Line --•-••�-•-•-- Distance�to nearest: Well ---=------------• . tI Date ---._:---•-------•-------•--------) y REPAIR/ADDITION(Prev.1 Sanitation Permit# •••• •--•--•--•- ................................•---..._.•-•-----•---. Septic Tank (Specify Requirements) ----------------------------------- -- eci Req ........................•-....---•--••-• - ...,. .,.:.. Disposal Field (Specify ------------------------------------------------ ------ • ;:,• .. f r .................................... I ` (Draw existing and required addition on"reverse side) certify that l have prepared this application and that the Sa�k will, Health Heal h Distne in riictnHome ce town r or (ices 1 hereby'., t County Ordinances, State taws, and Rules and Regulations of - �� arson in such mann sed agents signature certifies-the following: I shall not employ any p I—* "I certify,that in the performance of-the work for which this permit,is issued, ,.J ' as to become subject to Workman's_ Compensation laws of California."' ;L .....-••------- Owner• , i Signed .-i -------------- ------ Jitle -- &VJ ;i` 0= —.." (If other th8n owner) FO f R .DEPARTMENT USE ONLY l } -:.. _ . .-...._.. DATE ..... ! APPLICATION ACCEPTED BY :s.:; DATE -------------••---..__..----.... �.......................... = ................................................. - ---••-----•-----•-•......_........... BUILDING PERMIT ISSUED .__-.-- ADDITIONAL COMMENTS ---------------- .............. ......•...._.............. ............ ' -----------•-----------------------••-•••-- ..... - ------------------------------------- - ----------------- ................ .. = 1............. � -•---....�.-----. . Date ••f Final Inspection by: SAN JOAQUIN LOCAL HEALTH DISTRICT ti