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FOR OFFICE USE: '%w APPLICATION FOR SANITAT1010"RMIT 69 Permit Iv;.................R...> ...__.................._......._...................... (complete In Triplicate) pntelssued..�-�"-�9 ,f ......._................ .. .... ............ This hrmif ExPiros 1 Year From Dat*Issued ....................................... heroin Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the orkons. described.This application is made in compliance with County Ordinance No. 549 and existing Rules and Regy Y N'» 1 ' i _^ JOB ADDRESS/LOCATION ...2...1...'�'-...L.T..-..- ....._V h.I..Q..�1a'.......................................CENSUS TRACT .. lg Y7 ...... .. . /fi / O.t'✓...a.. --•--• City .. ... Phone _._ Owner's Name .....�G.f ................... ^ ......... . __ ...-.. nAddress -----' ... phone P+3 Contractor's Name .C.... C.�._,.�.. � ' Installation will serve: eiol QTmiler Court fl Residence❑Apartment House Q Commec .. Motel ❑Other.................. _ Number of living units:............ Number of bedrooms ............Garbage Grinder ............ Lot Size ...... Private❑._...-- ......_.............._. .,. Clc loam Water Supply: Public System and name ........... Peat❑ Sandy Loam ❑ Y Silt Clay ❑ .,,',.. Character of soil to a depth of 3 feet: Sand❑ ❑ ' Hardpan❑ Adobe❑ Fill Mate:'nl I...........If yes,type--------------------- to wells --- (Piot plan, showing size of lot, location of system in relation , buildings, etc. must be Plawd as revere-SM NEW INSTALLATION: (No septic tank or seepage Pit permitted if public sewer is available within 200 feet) .. Size........... -.......... Liquid Depth ----- S -- MENT ] SEPTIC..TtK[ J Compartments ._....._-......__ ---------- PACKAGE Material...................... No. . Capacity .. ................ Type .................... i; . Foundation............ . ... Prop. line .. . . ... .....- .,. . ................................ ........_ Distance to nearest: Well _--• Total Length ..-------- .. . ...... . Length of each line . .................. IEACHINC-LINE [ ] No. of lines ..-. .yp .- 'D' BOX ............ Type Filter Material ........Depth Filter Mot*rial • Foundation lltte '- ........................ Properly Distance to nearcsc Well ........................ Vie ❑ �❑ t' t. Depth _ .. Diameter ................ Number ................:::::_.. Rock FiMtt/ SEEPAGE PIT [ ] """' . Water Table Depth .. ........................................Rade She ...............:..... une Distance to nearest:Well .................................... Foundation .. ------....._---hep. . . MPAII [Prev. Sanitation Permit t# ............. Da;e .... ..................._.........) ...._..__... ..._............................:........:_....__...................._.......... • __- + Septic Tank (Specify Requuements) -- - - """"' _ Disposal Field (Specify Requirements) ......A DD.......D"ST......a...x..-"-... --- -----------L�tdc.tf.....trt.rl�.<_...... .. p ..................................................................................................... ..........._............__....._................ _ 4i ........................................'............._................. ... (Draw existing and required addition on reverse side] licatien and fltof the work will be do" in accerdanee with San leNel : : I hereby certify that I have prepared this app -jt t County Ordinances, Slats Laws, and Rules and Regulations of the Son Joaquin fecal Health District. Herne owner or (icer %7�' }}, sed agents signature certifies the following: In such mann. ^ "I certify that in the performance of the work for which This permit Is issued, I shall not employ any persert as to b*COTO'su " ct to rkman s Comp satton laws of Califemia: nor Signed -. 1-f .. ..:,.. Title ._ .. .......................... 4 ......... ..... ................ . . .. .. ...... -.. I By......... ...... . ... r __ . pf other than owner) FOR DEPARTMENT USE ONLY ^ . .....c..... >: ."tt•, ..........DATE_..........:..::.:..::..:_:::..: ,;;.q,. . .. APPLICATION ACCEPTED BY... -Tt.-IZ-...41......................................_.............-............_........-. DATE......�..: BUILDING PERMIT ISSUED ............ .... ......_._......................._...._............. .f......................................_.__....._._........ ` - ADDITIONAL COMMENTS.. ...._� ............._..- . .... .-...._.._-.......... ....._............. .. .r'.. - ' l..- Jt .. .... ........................ . .. .. .... .-. ....... ..-...-....-... _ ..1 .................. _ _ ............................ � ._ ...._..- ..-'--_....._..._Date ............ .. ....... ._- _..��_. Final InsPe � ... .... SAN JOAQUIN LOCAL HEALTH DISTRICT r. _ E.H. 9 1-'68 Rev.SM I