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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT � .......'. ........ .......... Permit No. .f .. .. (Complete In Triplicate) J - This Permit Expires 1 Year From Date Issued Date Issued .. .` .......................................... •+^*', Application is hereby mad o the S� 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: t ir�agr / ids n F kel JOB ADDRESS/LOCATION .... :. .�` ��'... ... •- 15C f'r A(la,of A y yT U �.i ....................................../� GENS 5 TRACT . F. r •-•........Phone ... �`�:... l .Owner's Name ...... ................................................•---........_..... ................ Address ' - --------- ......... City -.- Y ! - Contractors Name -.-4FO-_AKAGIY�V...e---- -•----•--------- - ----------.License # . Phone .... . . . - � # Installation will serve: Residence{3 Apartment House Commercial OTrailer Court 0 � f Motel ❑-Other 1"v L i L Ho Mel Number of living units:..-- ...... Number of bedrooms ... Grinder ------------ Lot Size -. 1�n'-C-b.........................b1, 4. Water Supply: Public System and name ...-------- .............. .. ....... ......... ..=:-... ............__..-. --•-•.----:---------- --Private® I Character of soil to a depth of 3 feet. Sand b Slit Q: Clay:Q ' Peat(]�, Sandy Loam w Flax Loom 0 1 Hardpan [] Adobe-G .10.41-Mater al yes,type ............................. (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse slcle.)j�� NEW INSTALLATION: (No septic-tank or seepage pit permitted if .public sewer is available within 200 feet,) �. PACKAGE TREATMENT [ ] SEPTIC TANK f j Size.........:... .-. ... Liquid Depth ...:._.-:. ..... b Capacity .................... Typs ...-..--•=-........ Material---------------------- No. Compartments Distance to nearest: Well ....:----Ap.....................Foundation ..../O.....___•... Prop. Line .�.!.. �=-....... LEACH114G LINE [ } No. of Lines 4 ....... Length of each .. Total ,length. D' Box Type Filter Material ...! Depth Filter Material _.-.o m .•••.. Distance to nearest: Well ....... '........... Foundation i.... / ............. Property lin®, A.Z.7 ........... i SEEPAGE PIT j j Depth .................... Diameter ................ Number .... ....................... Rock Filled `Yea No 0 Water=Table-Depth # i..........Rack Size ...... -. Prop. Line ................ Distance to nearest: Well ................................... . Foundation .------....--.-.-- ..._. REPAIR/ADDITION IPrev. Sanitation Permit# .....:.:...:......................... ... Date '---------:........................ ) f SepticTank [Specify Requirements) ..................•--•--------------.........-....................'...................................................... Disposal Field (Specify Requirements) -----•-------•------•--•---•-•................••----- ..._`...-.-.-.....-•- ----I.............. ........................ ----------- --------------------- --------- ------•-••--••.............................. ---- ------------- ------------................. ...----•--•----. --------------------------------------------- -----------•-----. - (Draw existing and required addition on reverseside) # I hereby certify that I have prepared this application and that the work will be done in accordance. with San Joaquin C County Ordinances, State Laws, and Rules and Regulations of the .San Joaquin Local Health District. Horne owner or licen- sed agents signature certifies the following: F "I certify that in the performance of the work for which this permit is Issued, 1 shall not employ any.person In such manner as to become subject to Workman's Compensation laws of California." 1 Signed r?........ f... aN.................... ..... Owner By ............ ............................................... xitle ....--------------..-....- (If.other ed FOR .DEPARTMENT USE ONLY � APPLICATION ACCEPTED BY X1.4--------------- - • ................................ -------..---- DATE..-a—....=.--Zf:2.,:T,..--..--... BUILDING PEW11 ISSUED ................... ..:.............................I............................. •----. -.--DATE .................I......................... . ADDITIONALCOMMENTS ------------- _------------ -------_-- ----:..-----------=--................____...............--------------- ........................ ---------------- ----- --..._..------- -•---••----•--------------------------------•--...---------------..-........----------------------••------.._. . ............................. ..................--------------._..tib.r_-__-.._.. :::._.�....-._.... .................................-...............................................-------------.......... ----•---------•----•- .....- (. .�..� �.Q .�._ ......�....................................... ............._................. —t -- ................ Final Inspection by: .. 'i/ .. .................. ...............................Date -....�....` _.� .7.- ER 13 2h 1-68 He v. SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3 :