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FOR OFFICI? USE: APPLICATION FOR SANITATION PERMIT Momplete In Triplicatel Permit No. .Z ....................................................... ' rr This Permit Expires ] Year From Dat*Issued Hate Issued ....... Application is hereby made to the.rSan 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 ADDRESS/LOCATION ...... �=_..........��f'Piif�.�41g'...............CENSt15 TRACT Owner` Nal .hv<!N pas•`tf _... .............................................Phone .._._ s me ...-• Ph n ...R A 11...!N�4 .J Address ....... P Y rE Les ----- .. City .!_o-4,09 ................ Contractor's Name .______._------- -- ----- ------- .....License # .. Phone Installation will serve: Residence Apartment House 0 Commercial OTraller Court 0 Motel 0 Other---------------------`:..... Number of living units:_..__.. Number-of bedrooms __ . .._.Garbage Grinder ....... Lot Size ..�, ».. ,jam.,....,.,, Water Supply: Public-System and name --_ ....._¢a' _ [ ..................... --•-•..-•Private Q z �.......... Character of soil to a depth of 3 feet: Sand Silt(] Ciay"[l' Peat O Sandy Loom C] Clay Loam ❑ f Hardpan E] Adobe fl 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.[ NEW INSTALLATION- € (No sep#ic tank"or seepage pit permitted`if public sewer Is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TAMC ] Size..__ ��.�. Liquid Depth ............. s-- [� Capacity _/64�?Pe ----- o�✓G Material_----- !✓ -�Ia. Com [ } NoDist of Lino nearest: Well �'�'J��%/+�/�' G✓e! ow a , • ,� s; .. .. -•- 4444---•-4114 •---�...._....Foundatlon ._.__/P.--�•_._ Prop. Ine .............. 6 LEACHING LINE ` I S Lines _...4444-...4444--_=--•!Length•o€each fine__............. ------Total Length D' Box -----....__. Type Filter Material ....................Depth -Filter Material .............................................- i Distance to nearest: Welt ................ Foundati9n ........................ Props.�y Line ........................ SEEPAGE PIT [ Depth .../9 �� )C � ff`S S'G.r G✓r/ Diameter .�j�__._--••-- Ntfm er ....................-•l__---- ock Filled Yes No {] r! F�g�D Water Table Depth .................................- �r'r- z /Z," O 4 . .............Rock Size .- •- 4444-- - ..._..._.� Distance to nearest: Well �-Q'�?�•_.1^��f..•. ' F � ----..:.:Foundation �U.._.�._--- Prop. Line _-�... .......... '. REPAIR/ADDITION(Prev. Sanitdtion'Perry4t# _--___ Date ................... ) •---------4444-• - ••-------•---•- Septic Tank (Specify Requirementsl._________________._�_-_.__---._-444 1......-- ....-•---•_ .................•.•--•-- ....... . Disposal. field (Specify Require me ts) �._•- [,�,.c.�.c� -- - _ ---- •--- . -• --------------- r.. �a ---- • � • 4444---...__ ...---•-• s --------••---------------------------------•----= ...................................•--.....---....._...__......-•---.........•.--_--•••••-- _ 1 x (Draw existing and requiredtdition on reverse side) I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health;District. Home owner or Ilcew { sed agents signriture''certifies the following: - - - -- "I certify that in the performance of_,the work for which this ;permit is issued, I shall not employ any person in such manner as to become subject to Work on, en ation laws of California:" Sig ned�= '�'/ ��'`?'`-'t=__` --- ------ - ------------------------- _ Owner � -----4444-• -- - By - ............................... ..............---- t= Title ----------- --- i (If other than owner) � FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY,____�✓ __ - -- DATE _..,.. ..`.,2T_._=- _-_- UILDING PERMIT ISSUED _________ _ � --- - ITiONAL COMMENTS -------------- -•---------_----- -------------------------- -- ---- -- - ----- DATE .............•-• ---- - ---•---•---------------•._. --------- -- --•-- ----------------- ........... 44---4444-- -4444-- - - • - --- ---------------1•...................... ............................ - •- _ _...._.-•-•-------------•-------------..__.. .�................................ - Final Ins ection b -- _.._._--_. P Y� - --- --- - �• --- •- ---•----. .. 4444 - -_ •.....---------------------------------------4444--._Date ....----4444.-�-�/�--------------- I;H 13 2!a 1-68 v. SAN 10 CfIN i.C)CAL HEALTH DISTRICT 8/711 3M �