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FOR OFFIte_f USE: APPLICATION FOR SANITATION _ PERMIT _ �. Permit No.. - �.. 3 S �y ; E. icon►plate in YripliwN) _ .. 3.7,E -..................................... I Date issued This Petmlt Expires 1 Year Front Datrls�uad� I # ,_ ................................... .... it to herein r.� msCi install App}ikcatiomis_hereby`mode to thSan JoaqLoclHlthDistrict N549 o existing Ruesand Regulations, described. This application is efide in compliance h Ordinance odtT�- �"-' •a� �1.-r �%q ...CENSUS' ..CESl! TRA CT JOB ADDRESS/LOCATION .._... .•.....�'" _ r�- -••-... .�.. �.aP.��. �-.._. ............................... Owner's Name ....G..4./.G< - r--;............... • Address .............................................. :........ .:_ -• Lease # . .��%rte Phone. r G.. .............. Contractor's Name ._.�-r1 martial flTrollet Court Installation will serve: Residence [3 Apartment House {� _ Z el her ..................._._....._.... . :. - �e 7nGarbage Grinder .• ..... Numof bedrooms _.__.._..___ Lot Size Number of living units-.. -- Private ❑ ....- ..._...._ name 4 Water Supply: Public System and . Say Loam 0 Clay Loam ❑ j Character of sail to a depth of 3 feet: Sand ❑ Slit 0 Clay" P.t Sandy "'Hardpan C] ' Adobe Fill Material_;_,._-........ If yes, type' • (plot plan, showing size of lot, location of. ;ysfem in relates :to wells, buildings, etc. must be placed on reverse side.) NEW tIdSTALLATiON: (No septic tank or seepage pit permitted if public sewer is available within 206 feet,) ._ l — - PACKAGE TREATMENT I SEPTIC TANK( } 'Size ..... - .............., ..... . -� - No. Compartments _....•.-. ..J Ca' Ci '=•_.._.� Type .... '..-=`Material•-- .............� J pa ty ................ rop: in ................. Foundation .. P {I Distanre. to nearest: Well.........................._ i Na. of Lines Length of each line.-_ ......................:. To#ai. Long i , .......... LEACHING LINE - [ } De th Filter Material .......... i p .� 'D' Box ............ Type filter Material .....---.... Distance to nearest: Well . ..._.....•.....�/Foundation .................. ------ Pro e.rty Una :...... r_' o �''�.-•.�_.'.._. piameter-•` }l ----- i - Numberd.............�a........'... Rack Filled Yes � SEEPAGE PIT (j� Depth }._.. - ,.: , ._...... -------1Ci � `Rock Size ...•.�.�-�.=--~�"� 2? j••-• ...... C/ ' Water ;Table Depth _.._....••.... - , -•-t � O / Pro Llne �.%�� y s ._.:.Foundation ._..:........... p. Distance to nearest: Well ......./.c67 �-� Prev. Sanitation Permit �k` , `. Date_' .................:.:....••---••- . REPAIR/ADDITION #=..._._.._ ._..-..I-...1.-...._.1 .............. L -h_... `` .......................................•. Septic Tank (Specify Requirements) --••-._-- -_....... Disposal Field (Specify Requirements............. ........................ f .............................................__..................... .............................................--------------..._..........__...............-•-...............__ ................(Draw existing and required addition on reverse si e I hereby certify that 1 have prepared this application 4 t}d that foie work will be dans It DistAaccort. M with Son coagula County Ordinances, Stat® Laws, and Rules and Regulations, of the San Jdaquln Local Hsailh:Qistrict. Hoare owner or 4itats• l sed agents signature certifies the following: ,,.i arson b such manner "I certify that in the performenee of the work for which this permit is issued, -,I shall not employ any p as to become subject to Workman's Compensation taws of California.,,i �._...._tS�-c��"rOwner _ ��-?T//fir ..rte.. Signed ---- ...------ - ...-....;.. Title :..-- _ . i {If other than ow+nerl E t FOR QEPARTMEN� USE -.ONLY DATE ..... --------- APPLICATION ACCEPTED BY . _ .._......- --•• ..DATE ...._................. --..... BUILDING PERMIT ISSUED .....-.:................................... ....;;__:.. T_ :_... ..................:.........--•••••••......... ADDITIONAL COMMENTS ............ _ 1. - i t , , .':. . •� ....._..... ;. -•................................. _....... .... u............ t............ -------------------------------•--........ i Dae ......_..... ` Final inspection by:. ................................................. .. `'".... 8/7h 3M EH 13 2L 1-68 Rev. 514 SAN JOAQUIN LOCAL- HEALTii DISTRICT