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k FOR OFFICE USE ry` APPLICATION FOR SANITATYON PERMIT . . ...... . . _.�r._.. Permit No. .// J� (Complete in Triplicate! _.... ... This Permit Expires 1 Year From Date Issued Dote _ Issued..�. .�✓!� Application is hereby made to the San Jenquin Local Health District for a permit to construct and Install the workherein described. This application is made in compliance with County Ordinance No. 544 nd existing Rules and Regulations: ianL ?/- JOB ADDRESS/LOCATIQ^I 13 � A .. f _ TR . _ ...CENSUS ACr ._ // . Owner's Name .�� JGz1/P. r i! ._. hone ........ .. ... ,y /� /�� ...................... .... .. Address ...c�.'.�/.C.r .,/4�Gf><r��CJy I— ........ .................... City . _ae.nz 1.�2..rt�_......../...... [- Contractor's Name . .. ...Tz!......1�-ca-' :..... ........................ ..License#I�.1�?g -Phone �F? �/ Installation will serve, Residence[ partment House L-] Commercial❑Trailer Court .fl i Motel ❑Other................ .;� Number of living units: ........ Number of bedrooms j.........Garbage GrindevVa.... Lot Size '.SG✓Cf. fc_._ -• - f ! Water Supply: Publla System\and name .. _ ............ ... ... ...._.........: .. .....................__ ............ A t Choracter of soil to a depth 9tfeet: Sond❑ SlIt❑ Clny ❑ Peat❑ Sandy Loam[�-�foy Loa Q `• e '- ;),Opon❑ Adobe ❑ Fill Material //W.. If yes,typo_................. (Plot plan, showing size of lot, location of,*ystem in relation to wells, buildings, etc. must be pi verse side.) NF.W INSTALLATION: (No septic tank cr seepege,p_it permitted if public sewer is available within 200!eet,) 1 a PACKAGE TREATMENT [ I SEi'TIC TANK f 1 Size ................ ................ Liquid pAi .... _.............. r Capacity .......... _..... Type . Material.... ..... .. ... . No. Compo n nts ......__........... .�� x( Distance to nearest: Well ....._....._._........t Foundation..................._. ap•Llne ..........._......... �` `�. LEACHING LINE ( ) No. of Lines ..._. ............._.. Length of each rlae........_........_........ Total L gth ;......_................... 'D' Box .. .. ..... Type Filter Material . . .......... ..Dep"th Filter Muterial . ..-. J . . .................... 111 Distance to neare.,t: Well Foundation .. .... .- .... Pr�M�fne ... ......-.__.. s .r SEEPAGE PIT [ J Depth ............... .... Diameter .......... Number _..... Ro Filled Yes ❑ No Q ?,T i Mater Table Dept's... . .................R $ze ......... y�.k.f.......... ! . .. . 1 � 4 Distance to nearer Well _ _-r-"'^"'• naan .. ` REPAIR/ADDITION(�trw Sanitation Permit d- - t..k.�._._ �i Wte ... f... .l # Sepilc ionic (SPa4zY Requirements) .:_.. .. - .f ..... ;. ... I _. Di y � xpds GF'�d 'S�pcify Re4vlrsmenisl .... ... .. I,l+�"-V.�'Y! ......... ..... .�_. -�- -: ,y (Draw exl ting onrequired addition ar.revr.s6aldx 1 hereby ceKify the Lisar2 prepared,Ihir apPllcatIcIA and the: the work will be Fd* In accordance with Son Joagaln •� .^.aunty Ordinances, State Lows, and Rules and Regulations of the San Joaquin !.oval i!b District. Home owner or licen• i t sad ngenls signature eerpfies the;NLllowin0: "! certify that in the!perfermnnce f she work for which this permit is irsv+d, I shelf not,empley any person In such manna ,a as D become subject to Worl:mar�`s Compensation laws of California." y t� c 1 Owner -... . . -"'on OR DEPARTMENT USE ONLY t _ . fit of ................ .... . ._ .. . ... ... .. . AAA ... {If otheT�-s. owner , w L V g� A PLICATION Al"C`cPTED BY ♦"S�i" ... . .... DATE . aL aS �.L... B ILDING PERMIT ISSUED �} ... . ..-...`J .......... ........ _. DATE t ) ADDITIONAL COMMENTS . ..,rFl •.a^.�ar�iw,.• s.2.srirc^:...,+...e:[�t.. '7 y.r..:/ ..... .... ........ .. ....� .............................. .... .. ti < . a�2 ... / '�� . .... ...... . .. . ... ... .... - .. . ..... .. .... . .... .. ....:.._gid �..n..... ...... ....._.. . ..Dart -5'-.... ._ G:.. ....... . .. �, Final InsPoctian by: , s 14 .. -- " - t 'ir SAN JOAQUI:1v LOU, HEALi:k DISTRICT y. r« E.H. 9 1-'03 Rev.SM � „ 1•�-• s +