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`- FOR'OFFICE USE: APPLICATION FOR SANITATION PERMIT . . .......... .. . .. .... . .... ............................... Permit No. .C: �.: ICemplebinTdplieaNl � J ..........:.................._.......................... Date Issued .k..:7.4/�[N This Permit Expire, 1 Year Fret"Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and Install the work heroin described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulationf: JOB ADDRESS/LOCATIQN JRCC .MEy1aR$ .�A.RK _.. ...' ....CENSUS TRACT ...... .. �/ Phone,S;;- ._.31/ 0 Owner's Name .... AmES... ...CAP.4�/ Address .- Ci cD l sro.... I�.�//. CLlavS .. . 8A ..City M Contractor's Nome ZWN 9 .. .. .. . .. . ......... ..... .... ...License# ... . . .... _.. .. Phone ................... .... ' Installation will serve: Residence F-1 Apartment Hovse❑ Commercial ❑Trailer Cwsf [R� Motel ❑Other.... ! .... Number of living units: .f...... Number of bedrooms . -.. � ...Garbage Grinder NV.... Lot Size ..6.4. {Pgor... ..... ear Sand Loam Cl Loam ❑ e�r Water Supply: Public System and name .....R 11(.. ti......:yT�!:—w�AT R--- �RIIJ--' "�--Privet ' w : Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ ❑ Y ❑ Hardpan❑ Adobe ❑ Fill Material ............ If yes,type.............:.............. I *, { s (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverie s(q�� • E NEW INSTALLATION: jNo septic tank or seepage pit permitted if public sewer is available within 200 feet,) r 1 PACKAGE TREATMENT [ ] SEPTICTANKj ] Size....3.X../ ...��............... Liquid:?epth .. /i—•-••-- ') Capacity _.15C.0..... Type f3............. MaterialG9.N�.......... No. Compartments .......�Z..,......... 7 R C... ' ....Foundation �� ....... P 9p Line .. .._. a Distance to nearesh;tWe I -�--. --. - r LEACHING LINE I' ] No. of Lines .......�... .. Length of each line. /�0............ - Total Length lQ�... ..... f' x Na. Type Filter Material RO.C'K,aOepth Filter Material .............. -"-.,------- `. ( �� PropertyLine ... ........ Distance to nearest: Well. .. s..C•W,Foundation : -..--- - SEEPAGE PIT [ J Depth .::.-....._....... Diameter ................ Number ......._._................ Rock Filled Yes ❑ No Q Water Table Depth Rock Size ............................ 1 Distance to nearest: Well .....................................:.Foundation _.............._.. Prop. Line ...................... 3 i REPAIR/ADDITION(Prev. Sanitation Permit# ................:_... ..................... Date .......... ..................... .) 3 ...---..... ............... Septic _ _ t ; Septic Tank (Specify Requirements) ..._.._..__.................................... ... .........._............._.........- ............. _ Disposal Field (specify Requirements) ........................................................................................................................ ..................................................... . _....................._......................................_........_....._.._......-...;:.-.....-...._._........................ . .......".................................. < (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be done in accordance with SaR,?Jeagaln , County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Herne Owner,Of(leen- t t' sed agents signature certifies the following: en to su[h manner `- •11 certify that in the performance of the work for which this permit b issued, I shall net employ any Kers as to Is object to Workman s 6eypensaHon laws of Califemia:' c. f Signed ... ... _...... Owner / '� ... 'j� �✓ .. . isle .......... ...... . ..... ._ : B .... ___ - _ i (If other than owner) FOR DEPARTMENT USE ONLY / _ .. ... . ... DATE 6.n17 APPLICATION ACCEPTED BY_T,r'- .- - - - _ .. .. ..... ..._ .. .. DATE - - -- _. BUILDING PERMIT ISSUED ADDITIONAL COMMENTS /?�7J1�Q l _ .. Y7 ._...._ enhy��/Finul Inspi ' ' '&�� .. - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M