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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ] ----------------------------------------- - Permit No - - ------------- ICompleF,*in Triplicate) ---------------------------------- EDate Issued �(' This Permit Expires 1 Year From Date Issued i ----------------- ------------------------------------- X !j Application is hereby made to the San Joagtin Ldcal"Health District for a permit to construct and install the work herein described. This application is .made in complianc6 with County Ordinance No. 549 and existing Rules and Regulations: r JOB ADDRESS/LOCATION __.� f-9 .--- ------ ---- 7-_�_� lV------RP. -----CENSUS TRACT --- �_ ------- Owner's ------------- ------Phone ------------------------------------ r ----------------------------------- Owner's Name -------------- ------- ---/�1-� ------------- [� 4 Address --------1756 -------- ---------- _U.:5''�11V------ D-----__ City ��----------- - ----n---- - Contractor's Name AVRPHj� -- / Cl�J7F0 $E-R.14 License # ------------------------- Phone ---------------------••- Installation will serve. Res�ci ence e-A-Mtm-ent-House-,[5-Commercial-i❑Troiler Cour-t_Q $ Motel ❑Other------------------------------------------- + j! � p ` ____________________________ Number of living unEfis:.._.,_ ___.....NV,mber of-bedroorras—: -_=.__.Garbage_Gr�nder_ _ S- Lot Size ---------------- �T Loam Private,el I Water Supply: Public System and name ------------------------------------ ----------•- _--•-------- --------------------------- Cha�acter of soil to a depth of 3 feet: - Sande Silt❑ —Clay ❑ < Peat-E] San' y ❑ Clay Loam:❑. Hardpan ❑ Adobe E] Fill Material ------1f yes, type ------------------ --- ----- I (Plot.,p=lAn, showing size of lot, location of systeM relation to wells, buildings, etc. must be placedl. on reverse side.) L �k 1' NE,1N INS7 iLATWN: -{No�s.eptic_tank4or see ;:pit permuted_if�pvblic^sewer iavailat�9'e vvithjn 200 f£et,l I �r PACKAGE TREATMENT [ SEPTIC TANK Size-57 X_!_��C_-�.-i__-__---_____ Liquid Depth ___ __ _________________ Capacity 15'0_0.... Type� > Material_CVN�""—Noi Compartments --- ---- _.:-•-- + Foundatio ---F ..{_ =j Pro Line _ S. Distance to nearest: Well ____�_.'�---------•---- - - .•; p•� � LEACHING LINE No.of--L-i es _�--------------- Length of each line-_--- ----- TotalffLengtW ___ -----_---___. I 'D' BoxType Filter Material Depth ',Filter +Material i ___I- t----------------3............ t Distance to nearest:�Well _--_6- 'j`___ Foundation __.._�i ---' "�=-=P�rrOperty Line ___ � ___ -.:••-. SEEPAGE PIT [ ] Depth --------------- Diameter ------------k--- Number .------_T- i:----------- ----------------Rock Size --------- ------------- Rock, Yes E] No Ct ; Water Table Depth �.- � •----- Distance to nearest: Well -- '----------- -- ----------------Foundation -----!------------- Prop. •- ':'1 Line ------_-------------- REPAiIRJADDITI!#ON_{Pev-Sa,nitotaon2ermit#_- ------- ------`Date ----------------- --------- ' Septic Tank (Specify Reqeents) _ ` N L #4 ---------------------------- / if —Req uirensN4s)V t � Disposal Field (Spec �� - - 5��/FACT0K------U��D-----FO_ R PLf-1C > _ --------o. s ------- ¢ � p z —� t._:_. J `Yl' �'=-" .:-.::-= _ ,...— -- ---- (Draw existing and r equired addition on reverse side) ' I I her by ce i -that-l-have-prepared-this-application-•and-that-4he work_will_be_donec in accordance with San Joaquin ;. County Cadinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: ! ' "I ce�fif7 fhJ't in the performanc hof the work for which this permit is issued, I shalt not employ any person in such manner M as to be a subje Worm �s Compensation lasof Cal'sforni�'�� '��t1 Signed /i''L� ---------------- if!-at2,i� �#-)p vner== 'J j E3 f-R-"v Title -------- --------------- - _ t--- c------------------------ By (If lother than owner) FOR DEPARTMENT USE ONLY ] EE pp DATE . 'rr-Q- 7�-3 APPLICATION ACCEPTED BY ----- l/1'C7 ---------------------------------------------------------- --- --- f _._-DATE ------ ------- BUILDING PERI.. 1—ISSU.EA__---- :' ADDITIONAL COMMENTS ------- ----- �- - --- ------ -------------- ---------------- -----------------=--------•----- ------•----- -------------- --------------------------- -------------- - ------ - ------------------------ ---- -- ------- ------------- ----- -- -- 1 ------ -- -=---------- DateFinal Inspe SAN JOAQUIN LO AL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M