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FOR CtFFICE USE: APPLICATION FOR SANITATION PER. G . "" •.r Permit No. (Complete In Triplicate) � ....... ............................... ... ... . _... This Permit Expires 1 Year From Date Issued Date ................................................. Issubj •f. Application is hereby made to the San Joaquin Local H=alth District for a permit to construct and install the work herein i. described. This application is -node in compliance with County Orriinance No. 549 and existing Rules and Regulations: s JOB ADDRESS/LOCATION It17(_1 .. y..'�.�T.E.I.(.�L. �.Cf�-- _....... ........CENSUS TRACT.S..'..7.. ....... Owner's Name ......b,JE. �..� 17 L.(! 1 R.N...................•-----:............ .. ... ......... .:..Phone .�.. .. �,. . 1111. .c��- ty --------- -----ci ..P�A. K. DA. h. � .. Address ..._ ._�.''yS� �.. D . Contractor's Nam> �A � ..�� .r.' 1.1-.�:•..... .!......... . License # ... ... . ..........: . Phone Installation will serve: Residence®'Apartment House❑ Commercial ❑Trailer Court C1 Motel ❑Other ``' i Number of living units:.....I.... Number of bedrooms �3 ..Garbage Grinder/F-5. Lot Size ..... K Water Supply: Public System and name ............................ .. ............Private e� Character of soil to a depth of 3 feet: Sand L7 Silt❑ Clay`El Peat❑ Sandy Loam E] Clay Loam �- ( Hardpan ki,�Adobe ❑ Fill Material 1l - . If yes,type.....777=... (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT (�J ' SEPTIC TANK[ ] Size:.... J .... Lir•.,id Depth . ........ v YCapacity .._.. ...... ..... yp ............ .....�. ral _. No Compartments 4 T e ater....Foundation Prop. Line ....... ....•-- v ' Distance to nearest: Well yLEACHING LINE [ ] No. of lines Length of Qch line ........................... Total Length .Depth Filter Material .... .....:............. 'D' Box ...... ..... Type Filter Material Distance to nearest: Well .................. ...:: Foundation Progeny Line ........................ SEEPAGE PIT [ ) Depth Diameter ....... �Nymbe. . .. .... ... ...... ... Rock Fitted Yes ❑ No - Water Table Depth 1 f Rock Size . ................... ;. Distance to nearest: Well ..... .......Foundation . .. . ...... No Distance ..... .. ..... .... . v REPAIR/ADDITION(Prev. Sanitation Permit# .. ............ ... .... Date r .............. ) h r Septic Tank (Specify Requirements) ... ...DIST'-.�f�x. .' '-� b1 ..aDX N-1 / Disposal Field (Specify Requirements) .FCR .. . ..FerrvR --. XP/gN.�LQNIt I iEAU�1 .-.. k... .. ...w/.A.� ....._..l ....Z.� W►D .._— .. . S E.PRb ......PoT..s rP SA (Draw existing'and required addition on reverse side) 1 I hereby certify that 1 have prepared this application and that the work will be done in accordance with S^^ Jooquln County Ordinances, State Laws, and Rules and'Regulations of the.San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: "I certify that in the performanc- of the work for which this permit is issued, I shall not employ any person in such manner as to b rye subject fo ark s�mpensation laws of California.."' 1 Signed . Owner .. title ._. ..... (If other than owner) FOR DEPARTMENT VSE ONLY APPLICATION ACCEPTED BY..'T�+R' - . .. ..:......... DATE ...�f".. ��. . m BUILDING PERMIT ISSUED .- ._... .... ... .... _.. _......... . . DATE .._ ADDITIONAL COMMENTS .. • •.. ...... _ . .. ..... . . . � . _ . ... ... Date 1 Final Inspectron by: . SAN JOAQU!N LOCAL HEALTH DiSTRiCT E. H. 9 1-'68 Rev. 5M