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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. ..--..2 � ........._...... This Permit Expires 1 Year From Date Issued 1 Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and Install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS7RCIGATfQN' � jp-y �• i ,�, _„_CEN - US TRAQ�•� - Owner's Name ..., !]}:IYI�---....1.1..A. .�LL'. ---...-. . . Phone lIl'f,�"44ir ........ Address ....-'......... .. ..a2Sl-.--..11t�-�x'�.f-..Rl.�!✓ City .�!�.-dYT�GA--'-'- .._�-"-'-'................-' ---" Contractor's Name ....License *V6715-11? Installation will serve: Residence®Apartment House[] Commercial(]Trailer Court !] Motel C]Other------------------:ii.,.-...--------------- 1 Number of Iiv - ..-'----"------.... ...... -- ing units:_.___ Number of bedrooms .-- ---.Garbdge Grinder ........:... Lot Size ..-----.;..................:............... Water Supply: Public System and name ................................ ).-,----Private Cg 1 . .... Character of soil tpa deptKV-J fM, -StfridlD---Silt❑—GioyCj_••.peotfl--Sandyioanl X ClayLoam 0 i i Hardpan Q Adobe ❑ Fill Material ..".".---... If yes;type ..........._E...... (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 I i ' If] '.SEPTIC TANK 1. ]� Size....----"---'-"-'---..-.-...-'-------'--�. Liquid Depth ...................... 6 f r !opacity ...--......-........i Typo --------------- -!.. FAaterial-..-.....-----...... N`o`. Compartments --........ _......._ � Distance%to nearest: Well - 1 - - ----------------.-......-.Foundation -------------....... P4. Line................. 00 tt ' LEACHING LINE [ ] No. of Lines _........... .. Length of each line--......"-.........-----.--. Total Length I 'Q' Box .-__�__ , Typei Fiber Material ...:................Depth Filter Ma ria! ". ... -.-_--,_-......--.....-----.--.. A �— -�.; I Distance To nearest: Well .......................`.�J:oundotion "_.....-.-. Prope . Line ....--.... ......... r SEEPAGE PIT! Depth . -` '+ '+Diameter ......... .Alumber ...------..........."-...... .Rock Filled Yes ❑ No Water Table Depth-"---.-----„Y,-"""_f=_,-._...:.-1.RockSiie „-:.-,J, . Distance to nearest: Well ..----'------ -'� _-----.-.-.Found/gil n * P p. Line ............ REPAIR/ADDITION(Pcev. Sanitation Permit .................._-,-...... ---iQ., Date .."--.--..._--.......-::-: ( �, { 3 Septic Tank (Specify Requirements) ---'---------'--'-------' ---------------�y.- ---•i-----..---`--- ----------- 01 - ��Ec y� } r �....-,.,.. - — -- - Disposal held (Specify Requirements) ....................r.-..fi.,e%Y..•.Lc .-.-.p7.,-.,�N,j(r.>G ---_ __ -1f �.CQN�. . ..-.-...............................f - �_��Drawexisting and�r�quired additi^ on onTreverse si`d8}--^"` _ I hereby certify-"tWo have prepored this appli�afion and lhaf,�e werk will be done In accords a with San Joaquin County Ordinances, State�4��.,. and'Rulei a_ntT�kegulSfiens3flhe�'S`an Jo'Squin LaCM He51tMOisttlCt: Home owner or licen- sed ogents siinaturecettifies The foliowing' + �' > +'^�^'^^^-^^—� j "I coda that In the ' f codify performance of the work for which this permit is Issued,'1 shall net employ any parson in such manner ” as to become sub ecft kman' ompensatian laws of California." i Signed ....-.. - `+ ....... . Owner By ------_........t_...................................-._......................................... Title .------------------_----___..._.---..___l._......._. i(If other than owner) ( i FOR DEPARTMENT USE.ONLY APPLICATION ACCEPTED BY --- --- - ---- - - ---------------------------------------:... .. ----..... DATE ...�.-.3c2-.7�.........-._.. BUILDING PF�RMIT ISSUED ---------------------------:---------........ .. ----'-......DATE ..__.'................/----------- AL COMMENTS ---- ---'------------ `-. . : _. c • -- - - •'---------'--" ' '-' -- ..__.........:.. .............: -- .......-- . .......... -- ----.............................................._,-.................. --------- ..._...-_.._..._ ........11....................................... ....... •yam - ---.......................... ...-..........----_..-.._..---............. ... . .............--��---�-----.....�.1-...._.-.... Final Inspection by: _...--- -�+-� ..---------------------:---------•......•-.. - • ..:...---Date ... ._`_. ..l�.--_.--/'------ SAN JOAQUIN LOCAL HEALTH DISTRICT E.H.9 1-'68 Rev:5M.