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FOR OFFICE USE: _.. . .... ...................... APPLICATION FOR SANITATION PERMIT ..... _ __.. . . Permit No. (Complain in Tdp:'caM) This Permit Empires 1 Year Fre`m Daft issued Dcte Issued ................................. Application Is hereby made to the Son Joaquin Local Health District for a permit to construct and Install the work herein described. This application is made in comolionce with County Ordinance`No. 549 and existing Rules and Rpgu!attonsr JOB ADDR"cSS/LCIC/A'TlION _Z. Q.. ..)...Fj:P .C�G�F -..�> •�!/-' -... /,.......CENSUS TRA16T ......._.... .------_._— Owncr's Name .....W,._../. I. ........ /Y...�.<r� ......._...................... ........ ...... .....Phone Address ......//"U ....'k/ ../ 'i.-..... ...............city......ar A/�C/J'V/[/. ....:....../.... ................. y, Contro tor's Name ...f�E. ,..,s' �YC'.. . .SFJt. ........... ....... .License# /77L/6 0O.. Phone .5�n'�'S. •%� - Insiol!otion wi!I serve: Residence JZ Anartment House Commercial ❑Trailor Court ❑ Motel❑Oilier ........ .. ......................... Number of hv'ng units:.... Number of becircoms .....Garbage Grinder Lot Size .2L' �;��( .........:.. Water Supply, Public System and name ........................................................_........................... ....... ....Private a Character of soil to a depth of )feet: Sand(�( Silt❑ Clay ❑ Peat❑ Sand/ Loam ❑ flay loam❑ ,. Hardpan❑ Adobe ❑ Fill Material . ..... . . I"yes,type...... .............. ..... (Plot plan, showing size of lot, location of system In relation to wells, buildings, etc. must be placed on rewrse Ode.) NEW INSTALLATION: INo septic tank or seepoge pit permitted if public sewer Is available within 200 feet,) Q PACKAGE TREATMENT ( ] SEPTIC TANK]] .r' . Size......................... ._. _..... ......... Liquid Depth ....... . ......... ...... ln.� ........ Type ..... .I............ Material..... ---------- .. No. Comportments Distance to nearest: Well Found0on .................. Prop. line _.................... `N LEACHING LINE [ ] No. of Lines . .. .......... . Length of each line._.......... .............. Total Length ......... . .... .... . . 'D' Box ....... Type Flifer Material ....................Depth Filter Material ..............................._.......... Distance to nearesn'N*II .. .............. foundation ..... ................ Property line .. ............ ....... �. SEEPAGE PIT t ; Depth ...._...._........ Diameter Number ...... ......._........... Rock Filled Yes ❑ 'vO 0 l Water Table Depth ..............................Bock Size ...............................P• Distance to nearest: Well ........... __ ....... ............Foundation ..............,. Pro Line ...................... ikEPAIR/AZDIT1ONIPrev. Sanitation Permit#...... . ...... .. .............. ..... Date ................................ Septic Tank (Specify Requirements) ._ ......... _ .................... . ........................... .... . .. - ......... a , fZ Disposal Field (Specify Ruiremeetsl d� y ' """" """'" """""' .. . ............................... ............................. ....._............. .... ......... ........._ ...... ................ .I......I..... .... .. ..... r (Draw existing and required addition on reverse side) hereby certify that I have prepared this application and that the work will be don* In accord anp with San Joaquin county Ordinances, State Lows, and Rales and Regulations of the Son Joaquin Local Health District. Homo owner or Mon. sad agents signatum certifies the following: "I rerlify that In the form ce of the. work for which this permit Is Issued, I shall not employ any person in such manna ; s to become sub]e a ma s Compensation Jews of California-" 0gned . _. . ._ • .. . .. . ...... ..:. ... ..... . .... Owner By .. .. / . .. en n�. owner) FOR DEPARTMENT USE ONLY „�.,.... APPLICATION ACCEPTED BY... ....: ......... ............ ... ...... .. . ............... DATE.....g--'"='/... _.. .,. .... BUILDING PERMIT ISSUED................ ........................................................._.............................DATE............................._.. ...... . ADDITIONAL COMMENTS ..r.................. ........................................................................................................................ ........_..... ................... ..................................:........ ...................................- ...Date....�.' ... 7/ Final Inspection by: ..... .t...� � ��..................... .'..• SAN JOAQUIN LOCAL HEALTH DISTRICT E H 9 1•'68 Rev. 5M sk4h hie^E)tik},i s._+.ae ...a..r.: ,an oa. .e,4 w.,an.wv4d`•.t y'y�+> v ;:�,r�,$,. �a� a„F,rar;v�:rk:.5Y7)e3'�G�.t'�n t5"r1+�,•Wa.IS,e'#,t��: . i