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FOR OFFICE USt_: — APPLICATION FOR SANITATION PERMIT a ft ------- -_------__ (Complete in Triplicate] Permit No. --_ -�(g ----- ----- ------ This Permit Expires 7 Year From Date Issued `�- Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to,construe# and install the wor k herein described- This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ._-_ O-7Q. Owner's Name fi 6ENSUS TRACT ---- Address l.ly-' - -----------------Phone Address --- ��0-�--�---- -�,01��t<7��--- -- --- ---- /- - - City __0A_KY/1_4- Contractor's Name ---OLA_N j -------------------- �" == --------------- - -.License # ------------------- - - - --- ----- ----- - --- Phone --.--�-------- -- Installation will serve: 'Residence [ Apartment House❑ Commercial ❑Trailer Court lU otel ` Number of livingunits: Number of bedrooms :-•---- oms _ - T� -._---Garbage Grinder VO_ Lot Size __ - C PPY� Water Supply: Public System and name _ �_ '_-- ' , � ` p _ [ - Private ❑ Character of soil to a de th of-3•feet:' _Sand' ---------------=----------------------------------•------ ------ ----------- ---- --- a ❑�-Silt Clay" ❑ Peat❑ Sand' Loam,❑ Clay Loam -r= KHardpan; , Adobe' - ❑ Fill Material �'�_-:_..l fYes;,-type-----------=----- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) Pit NEW INSTALLATION: (No septic tank or seepa e t�peemitted-ifepublic sewer is available within 200 feet,) W PACKAGE TREATMENT--f 1 --SEPTIC TANK-.[-I- O Type ------------------------------------------ i - Liquid Depth ------ ize:_- P Y -------------------- TMaterial---------------------- No. Compartments 4. Distance to nearest: Well ------------------------------------ ---`-"---"-----•----- LEACHING LINE= Foydation ---- ---------.: Prop. Line --------------- - � � No. o{ Lines -- ------ -- - --•- Length of each line_-_-- )--------------------- Total Length•D' Box - ------ -- TYPe Filter Material -E•--"`'---- - g -------- --•-------- ------Depth Filter Material -------------- - - Distance to nearest: Well -------------------------Foundation ----------- .................... Distance PIT Property Line l Depth -- ------ ------ -. Diameter ----------`-----: Number -- - ----- ----------- ----- Rock Filled Yes ❑ No .I❑ Water Table Depth ---------- Distance - --- Rock Size ----- istance to nearest: Well --------------------- - ---- —Foundation Prop. Line -----------__-_- EPAIR/ADDITION(Prev. Sanitation Permit C# _---__-_ - � --•-' -!= - -------- Date Septic Tank (Specify Requirements) -------- ---------_ - " K --------------------- ------------------------------------------ _ Disposal Field (Specify Requirements) PLJC1` --� -- -- - - ---------i'�X-1-ST/h(� SEP lZoc7 C�t44. �o> R --- - 'file K_ »` Tt; -An1�4S� !N1 rtJ DX A� grequired 'lit i*P . (Draw existing and addition on`rever'se side) 4-z ' -- �- I hereby certify that'1 have prepared this application and that the woik will be done!in q County Ordinances, State Laws, and Rules and 4tegq latiohs' accordance with San Joaquin of tan Joaquin local Health District. Home owner or len- sed agents signature certifies the following:'+''t ,t°, , he S "I certify that in the performance of the work for which this permit is issued,-1 shall not employ any person in such manner i as to become subject to Workman's Compensation laws of California." ` Signed --- --- _ BY Owner �- - -- --�16.�'IL. . Title (If other th owner - --- -----" FOR DEPARTMENT USE ONLY APPLICATION. ACCEPTED BY--.---��__ f BUILDING PERMIT- ISSUED -------------`-----------------------------;----------,--------------. DATE Sf ADDITIONAL COMMENTS --------- - - --= DATE r � _------------------- ------ - - -- - - - _ --------------- --- - ___ - _-- � W ---------------- - Finallnspection F- -- -- --- -- - ---- -- ----- -- -- - - < �z- -------------------------- - --- Date ----- --- ----- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'b8 Rev- 5M