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I FAIR OFFICE USE: APPLICATION FOR SANITATION PERMIT r� (Complete le Triplicate) Permit No. .1..3.'.Z!9�. - This Permit Expires 1 Year From Date Issued Date Issued IQ..- '{•3 Application is hereby made to the SO-) Joaquin Local Health District for a permit to construct and install the work herein described. This application isgqmade in compliance with County Ordinance No. 549 and existing Rules and Regulationst JOB ADDRE.SSAOCATI N ./,.29� .e ✓/ P . -.�liG-irra.r� E CT _....... ..........0 N S TRA Owner's Name .... _e/� ....................._... ._..-- ... /1. ....................... .... .....�.... one ............................... Address ..N: s s 9.�Zj�_E. r /�..1�+ .� � _. ... ..-.r✓............... ............city .ol.-�.. r If—, / ....................... Contractor's Name . ... • _. _ . .................... ... .Ucense# ...... .... ........... Phone .............................. Installation will serve: ResidenceA Apartment House Commercial[]Trailer Court D ' b Motel 0 Other ............ . Number of living units! _ )... Number of bedrooms ....�Garbaye Grinder ........ Lot Size .......................... . ;y Water Supply: Public System and name ; ...�:L .................................... ............Private❑ 4 Character of soil to a� depth of 3 feet: Sand, Silt Cla❑ y ❑ Pwt❑ Sandy Loam ❑ Clay loam❑ � Hardpan[] Adobe ❑ Fill Material..........-.If yes,type ... (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc must be placed on reverse side,) t+ NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK4 Size.... CC SS .. 4iq�d'Depfh s ./ $V Jf ........... Capacity /,..0-�... Type .. Material o. Compartments Distance to nearest: Well ..............Foundation ....... Prop. Line LEACHING LINE [ ] No. of Lines .. ...�............... length of each line ..... ,�--.� Total Len gth 'D' Box .. .. Type Filter Material rQ1G. _.Depth Filter Material ...� ��-.-. -•/ /yamF- .. -1-., Y, Distance to nearest: Well A0... .... Foundation l�.Q................ Property line .. ........... SEEPAGE PIT ( ] Depth .. __.. Diameter Number ........ ................... Rode Filled Yes ❑ No ❑ 6 Water Table Depth .......................Rock Size................................ ... Distance to nearest: Well .........................Foundation ....... Prop, Line • t DDITION(Prev. Sanitation Permit# ..........t?.-40t!....A i....... Date ............... �. Septic Tank (Specify Requirements) _ ..... _-........_.. ='�• .... Disposal Field (Specify Requirements) ............................... ..... ............._.................... ---.................................................................... (Draw existing and required addition on reverse side) 1 hereby certify that I have prepared this application and that the work will be dere in occordann with Sen Jeegeln County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health District Herne owner or poen-j sed agents signature certifies the following: i "I certify that In the performance of the work for which this permit Is issued, I shall not employ any person in suA memser as to become Oct to Workmon's mpe satlon laws of California.,, Signed .i WK -- . ........................... Owner By .............. .. . . .. . . - . . ... .. ................... Title ......-......-.....-.......................................... (If other than owner) r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY :........................................................... DATE.... '. ....:� ; BUILDING PERMIT ISSUED ...... .. . ..... . . 3 .................. ...................................................................DATE.................. 9 ADDITIONAL COMMENTS .................. ................................................ .............. ..................................... ......... ................................ Final Inspection b ..... .............................................. . . .................. to .......... ! �,. SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1•'68 Rev. 5M �. . � ...r...N1 -♦Iw..}yr Vi,%'.4��'Y`.'4Q!AMI:�fiWR%A. �,....:. p0"NYNYW4�M'4V:W1vvIL.2' 1i.