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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ,1 Permit No;�� 14 .............................•-•-•••---------------• � :� (Complete in Triplicate) KY :.-•� __ . _Y._._ �.,. ^ . ................... ...:. : ...::.:..:.............: p Date Issued This Permit Expires I Year From Date Issued 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: JOB ADDR155/LOCATi N 9g ......... ....CENSUS TRACT .......................... ............. y . rP.�SorJ_,-aQ6-s....... .(fa.l-.t... 1�- .�.�.�4t°I�so ..Phone.,.36.F:n��Owner's Name -.... D T ....... Addressa�a7.... _..__ _ .Sf , .:�Ca:.. ..� � .. City ts /� � . . -.. .. 1. . # ......30...... .. Phone 4 0�... .. Contractor's Name ..LLicense ............... Installation will serve: Residence IgApartment House❑ Commercial❑Trailer Court 0 Motel ❑Other ... ................................. ` Garbage Grinder Lot Size Number of living units:...,/.... of bedrooms . _. .._ ........::.. ....:................................. ams :. _ Water Supply: Public System and n 1`.¢/pu'� ....-.....-• ---•• -L Loom ••• - Coy todmrivate Character of soil to a depth of 9 feet: Sand'❑ Slit❑ Clay ❑ Peat❑ r Sandy koa 4] Cloy . _ Hardpan ..Adobe❑ Fill Material ...... 1f yes,tYpe. .. ...... ........... ............ �- - ❑ l _ - I (plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must-be picked on reverse side.( r t NEW INSTALLATION: (No septic tank or seepage .pit permitted if public sewer.is available within 200 feet,( '-� f PACKAGE TREATMENT ( ] SEPTIC TANK I } Size..00.---Co C;•-•••............. .. Liquid. Depth ......:................-.. . Capacity Material..............:...:... No. Compartments ._..••••••........... ..-•----_._. Type ..................•- p tY. YP A' � 'ET �� A"7 ....... Prop. Line i �/- �, Distance to nearest: Well _(�-`_.._-_-.-. LEACHING LINE [ ] No. of Lines ---_-__ Length of each line----Tom'................. Total Length ......J. �/........__. t 'D' Box ............ Type Filter Material .Depth .Filter Material_.�;.------••••••• 7- ) r �G. --....._... Property Line . ........ ... ..... Distance to nearest: Well .- s/., Foundation . I D� _ Diamete` � , Number :. ........ . ...... Rock filled Yea Z No ❑ SEEPAGE PIT ( � Depth .•�------------ -• - . .... . . Vllater Table Deptfi ------ -----...............................--•Rock Size�....:.......... ....... �- t Distance to nearest: Well _..#=�` .........Foundation ._....�....... Prop. no ...................... REPAIR/ADDITION(Prev. Sanitation Permit# .................... ..... Date .......................•........ . rff,, Septic Tank (Specify Requirements). - ..__-.,--•---------•-• ....................................... .............................................................. . ll� i Disposal Field (Specify Requirements) .:--------•-•--------- ----------------------------------- ...-•--- ........................ ----- .-------..................••---------..__.......... ...... .........-.............I.........I...... p (Draw existing and required addition on reverse-sidel I hereby certify that I have prepared this application.and that the work will be done' in accordance-wlth San.3oaquin +� I County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Loco! HeaNh.Disirltt. Home owner or licen- sed agents signature certifies the following: 2:4".1 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 becom ub t/to orkma 's Compensation laws of California." Signed -_ � t/ _.. -_ .. .-_._...: Owner . - --'A SY ----- ------ -- ------------------- --- ---••- ----- - Title _.. j ----- - -------- ------ (If-other than owner! FOR DEPARTMENT USE ONLY ,. APPLICATION ACCEPTED BY DATE Z� -- 7 T_ __.. _ __._ ©ATf ...-. BUILDING PERMIT ISSUED --------- -•-- ADDITIONALCOMMENTS ----------------- --••-----_______--_. --- --------- ,------•-. ----------_-_---- ------------- ---....._.....__.-...-.._._..._....._..-... -------------------------------- _.. _._... -•----- ..._ ------------------ -------- ..._.... Final Inspection by: -. � ..............•----•- ©ate _.-1�--....J.�:....._ .........._. EH 13 24 1-68 �v. 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M x