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FOR OFFICE USE: r7�f Ar—)ICATION FOR SANITATION r — ' .- .------- .-_ ._-..:-. (Complete In Triplicate) Permit No. 6 ..................................................... This Permit Expires 1 Year From Date Is�4 COPY 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 ADDRESS/LOCATION .......... 3.-QQ_-_._W-._-_L F.I-,M�..........................:-......._CENSUS TRACT .. .- ..... Owner's NameL.Q�"7�.:.:...:.��..V.�.��'....--•. ...................:..:.........._....--•---------Phone ................................ . Address -.._..3�_.9..: .. ........ .......... /: ..... ..Q_.:.-- ........city _-_-�� C __. _.....__.......................... Contractor's Name ............© •----- ------------------- -----------•-----.::..License # .......... ........... Phone .............................. . Installation will serve: Residence rA"*partment House❑:Commercial❑Tra€ler Court C] " Mdtel ]Mier ... :! Num er of living units: -_. -Number .of bedroonns :• __.Garbage.Grinder I—A Lot Size . .t� .........: Wate 5u ply: Public Sys and home ��.. _Private,, ..- = = [ i Character of soil to a depth of 3 fq t: S d lit❑ I917 ❑ Peat � Sandy Loom.❑ Clay Loam — } Hardpan Adobe Fill lltla i !l ,..P � terial .. .�... I#yes,type ...............x-..._.:.... (Plot la showing sietst; cation�of-gstem,lfc€tion to.wells, buildings, etc, must be. piaced, on reverse side.) NEW' NS ALLATIONr �(Io septic tank''3r seeps pit permitted if public sewer is available within-200 feet,) ZZC/ �� PAC G TREATMENT I ]' SEPTIC TAMC - 1 d X ...... Liquid Depth ........:._ �,,, Size: Cpacity. .� 4�!• Type '[ .SL Material. ?NC. No. Compartments ...................... lstance to lr4 Brest: Well _-140....:71�`_....._._Foundation ...��_: LEACHIN LINE . of Lines= "' Length of each line..::.-��..� Total Length ........................0. : � t Box ;.5�fType Filter Material �:L: ..Depth alter tsterial .....--f•q--...:.. ...... .j � r, ........ Distance to nearest: Well ::.:.1Q-Q.. .... .Fou ddtion J.Q.:...:_..... Prop" Line ! / •---- •- P C'rY II SEEP GE IT ( 'De Dth ..-.-j?Let�� eter AF�Xl..� umber .......... -•._ .. Rode Filled .Yes ff�lo ❑ ` / !r Water bi y� . .,� ....... .:Rock Size �..z.. ...?1_ • ID fahet nearest: Well .... ./r�" ........................Foundati n .� i........... Prop. Line ...��..�`... REPAI /A DITiON(Prel'. rtiitation ermit# ......... f......` Date ..........,,:......... . ..... .1 t4 / 5e tic nk e . p �a (Specify'Requirements)quirementsl . ........... ....... a- -....•...................................:.................. ...................-••---..-•._._....__.,... Disi iosc I Field (Specifyaquiremen ) E. ...... f ... .. ..---•..........................•••_-•--- --• ••_-------._------•-••-•---•---- r•. (Draw existing�,and�requlred addition on reverse side) I here y;,rlertify that I have prepared this application Ad.tkht the work will be done In accordance with San Joaquin Coun -Ordinances, State Laws, and Rules and Regulations of the',San Joaquin local Health Dist}ict. Home owner or licen- sed a ent signature certifies the following: ` "I cert h W11or once the work for whlch jhis pe� It I Xissued, I shall not employ+n� person In such manner as to 0 kma Compensation laws vil Cc}liforr�i9."o Signe ............. .. 'Owner �O1 By ... ._ .._.. ... ... a-© Yitle F -. (if other than owner) FOR DEPARTMENT SE ONLY APPIi+ATION ACCEPTED 8Y ...... _:.. �....... ....................... ............................. DATE...,C /�..� .... lBUILD NG PERMIT ISSUED ....-...................... .:"....••.....--•-------::.....:..........-------......::......_.......DATE ...........:.�. .,...... `,......._..... ADDIT ONAL COMMENTS . ..- ... Fina11 ..w _ Date w ...... ... .... .......... SAN JOAQUIN LOCAL HEALTH DISTRICT F: H_13 24 i..-AR R... 5M 7177 3 M