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FOR OFFICE USE: (4 r APPLICATION FOR SANITATION PERMIT / ..............................---................. Qt4w rte (Complete in Tri rate) This Permit Expires h Year From Date Issued I Date Issued - 7-�-..�-<(( .. ................... ! 1 _ 6. Application is hereby made to the Son Joaquin Local Health District for a permit to construct]land install the work herein described. This application is made in compliance with County Ordinance No. 549 and exist n' Rules and Regulation s : JOB ADORESS/IOCATIotN __ ------ 7AD3_-_.- l\[......$_1.P�!►1.-.._.ft-b'.-'............ .¢O `SUS TRACE Owner's Name ......... D�,�+lg...A--.�ar?Mp! . ., ._...- .... ...- - - - _pp_. p.._..-_.f_A..�.Phone ... ......... ... .... ___. Address ........� f�0....w)..._._!]L.......IS�. . - =-....-•--Cfty ,:117�.pQ/�.. ._ 1....-----'-'--"---'--...,.- .._ 1 Contractor's Name ...IQLA.1.04-�r.A-11r------------------ -------...._...._._:_-.,..Lkonse tli ---------•---- ---- --............. Installation will serve: Residence 0 Aportm nt House0 Commercial OTraller"�. t Motel 0 Other---- ---------'........................_..- Num- ejyefji i�g ;nits:.--.-�.... Number of•bedrooms-. ..Garbage Grfnde/f { ~ -•••A SF--•S•.•--- Water Supply: l`ic System and name _ -............--"..... •`-- -- �------ -------Privafe$� ' Character of soil t,*& epth of 3 feet Sand . silt ; Ciay_Q�P�ndy Loa CI a loom 0 . - — - 'H "fit an - dg •"fitICJuCn7,d?3 if gos, """' ..l > (Plot pion, showing size of lot location of system in,felotiO`to,Wells, buildings, etc. must be placed on reverse side.) -NEW INSTALLATION: (No sepe tank or se^e�ps a pit permitted if public sewer is avoilablbl {i hin 200 feet,) i PACKAGE TREATMENT SEPTIC�T,},,K K `� Size,-- _. ._ ....... �Copotity./Z}•� Type, .mt-kA+Mcrteri O.N �n /N� j 4ompartments ...... -,ewe...._ "'�Distance to nbarest:�il --. -----...-...-...---.founrrdation.11/.,.•-. / .. Pr p. Line .... LEACHING LINE [yf No. of Lines e. . .. . Length of each If ..._h.7. ..............Notal Length . R- ��rr77�tt 111111 'D' Box vpe Filter Material l.!_atrr�3._ �) .1_ _lr xE�_ Depth �Figlt Materi . . �_._......C__�.......___.... Distances to'nearest: Well ..a�JO�_ __ Found on ..11.C__{�^.. periyl Line .h.7_.__+`� SEEPAGE PIT ( ] Depth Diameter ..._-_.-,... Num ...__..___.___., Filled yes ❑ No ❑ Water Table .Depth ......................................... ock Size _._............-........_ Distance to nearest: Well .......... ..... Foundation ---------- 4 Lina ..._...____.__- REPAIR/ADDITION(Prev. Sanitation Permit. ..............................._-------- Date --....... 1 Septic Tank (Specify Requirements) ..........._................................-. ......a................__-_...............�•....--.•--•-.._.._._._._.- i � Disposal Field (Specify Requir ients) ....,_,..........—...................�.__`�_.._.....___...__........_.._... }�.....�._..�.___,.-._.. ` ---------------------'-'---'---.... ...........'-'---"...-.•'--------"-'-'--.. -- _.. . 3 _._._,........_..._. .. ` ...__.,.....�.............. -----:---_-_---.-- --- - - - --..._.-. :------- .. A(Draw exlsting and required aa, iT79 r8verse sidsy I - 1 hereby certify that I have prepare)d this application and that thew t-11 be done lit act erdan • wlfh San Joaquln ' County Ordinances, State Laws, and Rules and Regulations of the San eaggn Local Health District. 4me owner at licen- sed agents signature certifies the following: "I once of the work for which this permit Is iss- ed, I shall not employ any person in such manner I certify that in th�de W k 's Com{ cation lows of California." y as to become su Wor r Signed ............................... By ... .........._.--- ---'----------..,..� ..,_,___-----------•-_----'........�.._ Title . ..---....._,.._.._.._...._._...._._..,___ -----......_...--.- (If other than owner) -FOR.DEPARTMENT USE fdLY APPLICATION ACCEPTED BY .-�fR_....•'.. ... . .................... DATE...�Z� BUILDIMIG-PERMIllISSUED...----------------------------_,_,,:_.._...__...---......--•-• '- ""'-•------------..........BATE.......................... 1 ADDITIONAL COMMENTS _ -__ .. ...__.. .---•�/48 .. _�{._-.,... _._�rQ '4154..._.._....... ............................ .......... .......... '--------- -•--------- _.................................. - l _ .. -- - -------- .._......._._.................. - ......._.. Final IrnPec - --- --......................... _-..Dat. - - - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M _