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FOR OFFICE USE: zs-3o-li .� APPLICATION FOR SANITATION r kilT FOR OFFICE USE: '--------------------------------------tcac (ComPermit Triplicate) Permit --------------- f i Date lssued_.J"-,9/ -•---------------- -------------- This Permit Expires 1 Year From D^te Issued L � 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 ADQRESS/LOCATION.__....V.7-S(a- - --- --- -- Owner's Name. -��-� CEN TRACT - h = P Pone-5.9i.- 9 -'- Address _ C 7 - -------- - s City.. _-Zip-_ I Contractor's Name .-- ------. is .� i�3 , F ,.�,.. 1� - --Phone--� Installa#ion will serve: Residence�i Apartment House_E] Commercial ❑ Trailer Court.E] 4 { ��.. .Numb Motel ❑.. Other---- ----"= _._ . Number of livingunits:___.._ er of bedrooms�__3..__Garbage Grinder..-_1-.,,...Lot Size_ I; ._.. -- ----------- - Water Supply; Public System and.nome------- :. Private +❑ ~ Character of soil to a depthaneet: Sand Silt Cla at ❑ Sandy Loam [j Clay Loam Harcl ❑ „' p ❑ Adobe ,' Fill Mat"rial-----= ---I,f Yes, type-----------------= ----- (Piofi plan, showing size of lot, location of_system.,.in-relation to.w-ells buildings, eltc. mb-it be placed on reverse side.) { NEW INSTALLATION.- (No'septic tank .or seepage 'pit permitted if public sewer is a�aiI641`e within 200 feet,) 1 t PACKAGE TREATMENT . ` Size------------ ----- � [ 1 SEPTIC TANK :I - Liquid Depth ------------ Capacity::. _.. ,_ ,._:-Type:----' . tarlai-- ------- _1_ _=---"No. Compartments = -' s Barest: Well-.'. . ---- - + ' t No. of Lines. Foundation.__ _-..__.-.Prop..Line_: Distance'.to.n LEACHING LINE. ) _ t , ren - Length.., - ---- gth-of each--lane.--:.... Total' Length..--- -- ------ 1 ,D. Box_---- ----- Type Filter Mate`rial ---------Depth Fit Material - - - � �. 1 -� -- � .., a �► f ,.. Zir .Distance to nearest: Well-,------ ��'�+ �Foundat;on_ ---------- ---------------- Pro SEEPAGE PIT me l Depth.. . Number. t L pert ---- -Qiameter- ------ ----=-- ,. Rock S _ N .), 4 r N ..�-. e�d �Yes ❑ o, , ) _ Water Table Depth-__".--�- # - --�-----�=- ---Rock Size --'�f---- -----'---- 1 ! Prop, Line-`----- ------- Dat _ �f REPAIR ADDITION {Prev:planitaion Permlt#Well--i "- —. j ; ----- � - q .. �,. �Foun ate .. L d on. , 4 7' Septic.Tank (Specify Requirements).....-:-----s._,,.-. v L� _ : i--------- ------------- ------ --`- :--- __ Disposal Field (Specify Requirements).,------"-,. _4G1,("-` -," u - y ----------------------------------------- ----- ------ ------ -------- ---------- �" -- --- ---------=------ - --------- . _ 9 Y E-- ------- _ _----------------- ,. ! k (Draw existing and required addition on:reverse side I hereby certify that I have prepared thisEapplication and that the,work will be•-done-in-accordance with -Son iJoaquin•County Ordinances, State Laws, and Wes 'and' Regulations of:the' San Joaquin Loca! Health District, Home owner o ..licensed agents ` signature certifies the following: 1' I ") certify that in the performance'of'the work"for which this pertiiit is,issued,, I shall not employ any person in such manner as to become .subject ,to Workman'sCompensation lawstof=Califon ia." - Signed----- --- --- -- : E � ; ------------- BY - -- ------ -- . - n er -- - --- ------- --- wTitle f other than ) : - FOR DEPARTME1 T USE ONLY: + ■ APPLICATION ACCEPTED BY-- A - --------------------------------------------- -------- --- _ . DIVISION OF LAND NUMBE -- - - -------- --------- ------ -'Q TE -- ADDITIONAL COMM `�-y -.G ._3:dUJ4' \.-- .DATE -. i = /� ! 4 M .r n' 1 ) f -------------------------------------------- .."___._. _ .. --- --------- -- - ------------------------------ Y r , .- . i ---- - ---------------------------I--------------------- ----------------- ---- ------------ -- .- - _ i -...____.._ Final Inspection by: i _ -- -- — _ i .. w ......_ • w 1324EH sa SAN JOAQUIN LOCALAHEALTH DISTRICT I F&52167/ 63M""''