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l FOR OFFICl54'UJE::_"- APPLICATION FOR SANITATION PERMIT F -----------------------"---= -------------- (Complete in Triplicate) Permit No. _�_�_0? " ---------=----------------------------------------------- ______-`_.___ This Permit Expires 1 Year From Date Issued Date Issued - -7- �. 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: r JOB ADDRESS/LOCATION ....2-j Z73---5---------/V-------RI_Po1V------RDRD................ TRACT ------6---------------- Owner's Name ---M CS'i------- OO4-ENDPORL---------------------------- ---- - ---- - --- - --Phone ------------------------------------ Address p city Contractor's NameOLVA/Ek----------------------------------------- --------License # :------- Phone ---------------- ----------- Installation will serve: Residence R<partment House❑`Commercial ❑Trailer Court ;❑ Motel ❑Other -----------�------=--='-------------- Number of living units:_._--_1___._ Number of bedrooms _�___--Garbage Grinder _�N-Q__-- Lot Size _CR i .-____........ Water SuPPIY- PubicS stem and name ___________________________________ +____ _ Private Character of soil to a depth of 3 feet: Sand' Silt❑ Clay'❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ I Hardpan Adobe El Fill Material AA �I(� 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 septic tank or seepage pit permitted if public sewer is available within 200 feet,} PACKAGE TREATMENT [ ] SEPTIC TANI Size!----------------------------------------- --- Liquid Depth .--"------------.--.,.._.. � Capacity ------------------- Type -F "' Material-•- ------- No. Compartments 1i...------------. IN �.y to nearest: Well ------------------------- -- ------Foundation ----------------__-4, Prop. Line -------------: Distance -------- :� ? LV LEACHING LINE [ ] No. of-Lines ________________________ Length of each line."{__--.__f--__-- -___ To"tal Length ------_ ____.__--___-__-.-.__ D' Box ------------ Type Filter Material _____,_____ Depth tiF.,iIter Material -------- __ _ _ Distance to nearest: Well ________________________ Foun ation' __:_" "---------------- Property L ne. -------------- . i SEEPAGE PIT [ ] Depth ---- --------------- Diameter ________________ Number ---------,--------------- Rock Filled Yes ❑ No 0 trw x^ Water Table Depth �Y --------`r- s--Rock Size' ---------=----------------- �' ► �x > : Distance to nearest: Well --------:- Yom_`-----------Fo6clatfon -------------------- Prop,Line ----------------------- REPAIR/ADDITION(Prev. Sanitation Permit# ___-____ _---_________________ p Date _-._ ------------ -------- I .� : Septic Tank (Specify Requirements) f �---__lAI1_Th�------- 4 Disposal Field [Specify Requirements)_ E�S`I` I�OX--------3-----_044 4-----X1.Ms_ -----70.-----`_6 ----4 .Q---- -------- ; vr�►_b-E--<-- 6_"__w _D�_- ---- — .... _.�___.� ; E ------------------------------------------------------------------------------------------------- i {Draw existing and required addition on reverse side) t �- I hereby certify that I have prepared this application and that the,work will be done in accordance with San oaquin r County Ordinances, State Laws, and Rules and Regulations of the San`Joaquin Local Health District. Home owner or licen- sed agents signature certifies the tollowing: "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in suit-Oimanner as to becoWsubj�ectWorkman`s Compen tion laws of California.'.' 3a Signed ____ Owner BY Title ------------------ - -------- ---- --------------------- (If other than ow er) *""-" tr"-`-FOR'D1-PARTMENT`USE ONLY`-"-! II APPLICATION ACCEPTED BYBOWN'� -`_ �+ s _ - -- ------------------- -- ---- ---- --. DATE -- BUILDING PERltilliT`ISSUED_ �� -- - --- '" "- - = -r ` = L__=--- ---:-DATE__DAT( --------------------------------------------.� ADDITIONAL COMMENTS ---� S7 M------/�f T 41. D--- Rl� --. - -------15�-SNC, t-7-- ---------- , EV44 41��S--- NQf Q��4 L€ ri"I'7#_' --- 1 •- -- W -L.. 711AN o` e sTF" A P-TSA I3� t '--T----AP_PRoV I vt �'t'ti}_ _Q1l nr 4�5 Kn�o_1 � _4. K = -- ANP_ =' ------------------------------------- ------------------- Final Inspecti n by: - ---------------------------Date =_.- -- - -- -- - - -- ------/CAL" --------- -------- SAN JOAQUIN L HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M