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,h . ,y, ww}.• .t.:�.p _1.. .. AAAA., - ,AAAA .,.M�Y•'_"'�'''L� 1. FOR OFFICE USE: APPLICATION FOR• SANITATION PERMIT I .......................................... Permit No. (Complete in Triplicate) r��+ _...................................................... Date Issued //-1' This Permit Expires 1 Year From Date Issued { ealth District for a permit to construct and install the work heroin Application is hereby made to the San Local Hz described.This application is made in L., ..jnce with Couniy Ordinance No. 549 and existing Rules and Regulattonss JOB ADDRESS/lC+C4Tl0 L.. .. .� ..-... ...-.-.. . J`P!trk. .-..- ......................CENSUS TRACT ._..`-'. . ... . �AA % -+ -............. Phon �. -Owner's Name .. .... .......city ._.........----•--- Address .................e-7-/ a ..... ........ �_O... � // 6' 07 ' r Contractor's Name....... AAAA- f ....G='vJ.........................License ........... Phone AAAA Installation will serve: Residence 4Apartment House❑ Commercial❑Trailer Court•fl - -_.. Number of bedrooms ...__.-_.-..Garbo a Grinder ............ Lot Size ^e~ Motel[3 Other............... '�. Number of living units:. Vater Supply: Public System and name ................. •-- _. •-•-•-••---.._...-------••-•-•-•----•-- ----•----_-._Private Character of soil to a deoth of 3 feet: Sand 0 Silt C3Clay ElPeat❑ Sandy Loam ❑ Clay Loam y Hardpan❑ Adobe ❑ Fill Material ............If yes, pe...........__._.__.._ {Plot plan, showing size of lot, location of system in lotion to wells, buildings, etc. must be placed on revere side) NEW INSTALLATION- {No septic tank or seepage pit rmitted if public sewer is avoi! ble within 260 feet,) _...--- Liquid Depth PACKAGE TREATMENT [] SEPTIC TANK[ ]. Size.........................:... - -..•-. o-- Capacity .................... Type .... .............. Material........... •---••.. No. Compartments Distance to nearest: Well ..... Foundation.._ '.------------_Prop. Line ~ LEACHING LINE j ] No. of Lines ........ ....... L gth of each line...................... ..... Total Length Depth Filter aterial " y 'D' Box ..---AAAA._. T,.F.a Filter M e'ial P ..:.::._......._...__- r -: .Y, •- AAAA._ AAAA_...__ •�� Distance to nearest: V ell . ....... ... Foundation .............. ......... Property Line r SEEPAGE PIT [ ] Depth Diameter ............... Number ..._......._............... Rock Filled Yes ❑ No Q Water Table De ..._......Rock Size AAAA .-•--•---......--•---•--- r:. ........... _AAAA---•---•-••- Distance to nearest• Wel' Foundation Prop. Line ._... REPAIR/ADDITION Prev.Sanitation Permit vF ..,..... Date Septic Tank (Specify.Requirements) .................................._......................-................_ ..............._. . AAAA Disposal Field (Specify Requirements) .........__ pp _ R n '�`": `_AAAA " ..............-.....-..._....._....._..._..................... ....... C•-"..x..�>. ............................_.. _._...... ...................9...........q........_...-....._......._... AAAA.. _.................. ..............._. t . 3" _ � (Draw existing and re wired addition on reverse side) 1 hereby cerkif ' �f J.have prepared this application and that the work will be dons to accordance with Son Jeaquit.. ;, Countj► Ordinances•, State Laws, and Rules and Regulations of the San Joaquin Local Health DtsMc".Home owner er Iiaso- sed agents stgrfaturo certifies the following: "I certify that In the perf6rmance of the work for which this permit is issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of Caiitorrila:" - r' Signed............. ....AAAA_ _ _.................Owner By•.-.• - ................................ Title_AAAA ......................................: .._....... f oowner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.... g-19...................._.............--•---.... .............................. DATE..�0._.7�, .'.. .►..� . BUILDING PERMIT ISSUED........................ ... ac_....._._. f DATE......................... ..._. s ADDITIONAL COMMENTS.... �!- jae•. .-•-•--........ ...._.._. .---..__AAAA _.._ _ -...._...._..... ..........moo$ �►JA::........� a::::::::::::- - - Final Ins :. ::::_......................... :Date.......AA .. ........ SAN JOAQUIN LOCAL HEALTH DISTRICT 1.'68 Rev.SM '-r �.k,,.a.=;N...s.o.. -_.�__.,_�._ _ ... _... .. AAAA.. _ . . - ++�:w.:;:�.:,•a-;,;i!,`id.�Ka•�`: . .i rx;