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� � t FCR OFFICE USE, APPLICATION FOR SANITATION PERMIT X02-6� ._.-. Permit No. _71-_A---Ly-.Z' -------------------------------------------- ( Complete in Triplicate ------- ---------------"-- Date issued This Permit Exp fres l Year From Date Issue l the work Application is hereby made is the adean compliance wical th Counttyealth trict for a permit to construct and Ordinan a No. 549 and existing Rules#alnd Regulations..e1n i described. This application .� ? J3 _:" -_CENSUS TRACT _k JOB ADDRESS/LOCA.T1.ON , z 177 -�-----�--O--------------- Owner's Name _ "---- lcity 1 R ------- ---- - 2 d"///""_ f/" __ ____ _ + _ _______________ _____ _ _ __ - F Address --------- f- C•ty r 5 / Phone - - - --- ------.License # a y 7 t - -- - Contractor s Name 1-�4 I .: Installation will serve: Residence ❑ Apartment House❑ Commercial ❑Trailer Court ; I � Motel F1 Other -------------------------------------------- � '-"----s----------------------------rbage Grinder _ -__-__ _ Lot Size _ - N Number of living units-./ Number of bedrooms ------------Ga y X Water Supply: Public System and name --------------------------------------------------------------- ----------------------�--------' Pr}w❑ate., Character of soil to a depth of 3 feet' Sand'[] Silt❑ Clay ❑ Peat El Sandy Loam ClaY,Loam;, I t Hardpan ❑ Adobe* Fill Material ------------ If yes, type __.-______-_ {,:-,1- e � k {Plot plan, showing size of lot, lotion of system in relation to wells, buildings, etc. must be placed on reverse •side.) . t � NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) F_t. SEPTIC TANK'[ ] Size ------- Liquid Depth --•t-----, PACKAGE TREATMENT [ ] `.. Capacity Type --------- Material No. Compartments i Distance to nearest: Well _________________"_"-- - Foundation Prop.,Line----- � !� �I Total Length ---- -- ---------•- . LEACHING LINE [ } No. of Lines ------------------ -- -) Length of each line--------------------- - g � g,. -De Depth Filter Material _---___ _ D' Box Type Filter Material . 4 j,", `- } Distance to nearest: We.11 ------------------------ Foundation _.---------------- ------ Property Line` -r"F a Rack Filled Yes ;❑; No Depth - --------------Diameter --------- Number rWkI SEEPAGE PIT [ ] - - kg ----- ..�, Water Table Depth, Rock Size I 1) Foundation Prop. Line _-_.-- -••--_---- S Distance to nearest: Well ----- - `t, I -------- REPAIR/ADDITION REPAIR/ADDITION(Prev. Sanitation Permit# -.3 Date ----------- -- .«v .� ______________________-.L__:__-- ___-------------- i k Septic Tank (Specify Requirements) --------------------- -------------------------tr----- y ------ �/ 1 Disposal Field '(Specify Requirements) .-" ---- --- - ---------- ----------- ---- i M i ----------- ------------------------------------------------------------ k -------------------------------------- --------=---------------------------------------------------------------------! _1 f (Draw existing and required addition 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 licen- sed agents signature certifies the following: { "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person i1n such manner as to bec a sublgct t W rkman's C pensation laws of California.' Signed � , �;X -------------------- Owner ---- --------- ---------- Title --- ----------------------- t (If other than owner k FOR DEPARTMENT USE ONLY 11 APPLICATION ACCEPTED BY __ - -------------------- DATE ---6 - �7 -------•---••-- _----- _ __ _ DATE ------- ----- ADDITIONAL COMMENTS __.! �0 �` = �'" '-�a" r �` �``�.n% uzr�.� c-dada ------------------------------------------------------ ---- ----------------------------- PERMIT ISSUED _._____ I -- -- -- --- ------------------------- .------------------ ----r . . J --------------- --------------------- f Date 1 - vA Fina� Inspection by ----- ---------- - --- R _ ! -a SAN JOAQUIN LOCAL HEALTH DISTRICT r " 0 1-'68 Rev. 5M _ _