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s FOR OFFICE U E: �_ .� APPLICATI�FOR SANITATION PERMIT . J:.a 70 ,.�a /� . Permit No. 64rrlQ rA (Complete in Triplicate) ----••�-Y.O - Date Issued ---•--.-.._. ...1�9 - - This Permit Expires 1 Year From Date Issued ........... ----------- ------ -- ---- i Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. Ihis Ifc tion is de in liance t County Ord•+na e S_549 and existing Rules and Regulations. f / �J. --•------ JOB RDD ESS/LOC�CTtON L . -0---' ��1=v�..n�'rCENSUS TRACT Owner's Name V Z--------- ---• ------------ --•--_........... ........................... Ph �3/ / .3� one ...._ . - - I.JQ: .� � . - /J /' Address -s'� - --Q'------ ------------ -----•--. City _15,15414r;ll----------- . .................... Contractor's Name ---If .-.Rf�G�/`------------- --- License#1�1c 2.9 _.. Phoney_,6'�- �1 t t a . Installation will serve: Residence Apartment House 0 Commercial ]Trailer Court 0 Motel ❑Other ----------- - -----' �`- i Number of living units::..4__Number of bedrooms ..._......Garbage Grinder .11c,::�* Lot Size �..R-�� ............... 1 Water Supply: Public System and name ......................... Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam 0 Clay Loam m ►Hardpan ❑ Adobe ❑ Fill Material If Yes,type . ................. ...... (Plot plan, showing size of lot, loc4tio n of system in relation to wells, buildings, etc. must be placed on reverse side.) � 1 NEW INSTALLATION: (No septic tdnk or seepage pit permitted ffIpubl�c sewer is available within 200 feet,) S PACKAGE TREATMENT SEPTIC TANK;. r Sfze. 9_?�e .•-•---.....-- -- Liquid Depth .- ................ Ca oci Zjaa - T e f �Q__ aeral.ed4=G••.••-- No. Compartment s _...___•.--._•..___ I P tY� �- --- -• YP �-�-• Mti ' Distance to ,nearest: Well _.., . ................Foundation ./V.- __ Prop. tine _l�.!�.__:...... LEACHING LINE No. of Lines.... ............... Length of each line..___-f' Total ,Length ` -•�•-•-------• ',D' Box t;:i... Type Filter Material l .�k44bepth Filter Material /o...�.-�.............•�......•••-- Y - -� Distance to nea`st. Well ---7P......... •-- Foundation ........... -- Property Line - D---•- r, SEEPAGE PIT Depth i-.o�i�- ---- ----- Diameter ✓-_..... Number _a� --- ------ - ------ Rock Filled Yes No ❑ i Water Table Depth ..... --- ----- ...............Rock Size /-.- _----•----- - ' I - P Distance to nearest: Well ___-.�.3Q.....................Foundation ._d�__ Prop. Line .. .._ ......._.�._. i REPAIR/ADDITION(Prev. Sanitation Permit#' ........ .............- - •---- ------------ Date ---------------•-------------•-•- Septic Tank (Specify`Requirements) ....... ----------------------- ---•-- ---••---......._. ........----......_..-••---- •-• ...... 0 Disposal Field {Specify Requirements) ------------ -------------_.............. ....... f I �� _ - ..-------••----------- -------- ------ ..�.J................. ....................................................i...... _.... f (Draw existing ond-required addition on"rAvd a side) f ' lication and that the work Jill b((Cdone in accordance with San Joaquin ( I hereby certify that I have prepared:-this_ppp' , County Ordinances, State Laws, and this and Regulations of the San Joaquin local Health District. Horne owner or licen- sed agents signature certifies the following: I "I certify that in the performance of the wort"Mi•which thk peimil is issue, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed --------- - ---••----------------- = Owner ............._!._. Title .. � ._.-_.... (If other n owner) FOR DEPARTMENT USE ONLY APPLICA'96N ACCEPTED BY - ---- - DATE ..--.Z.--._..31 - ._.. BUILDING PERMIT ISSUED -----------------------• --------- --..........- DATE . ADDITIONAL COMMENTS ••------_.. .. ......................._ -------- ------------•----........_------=-------.._.--- - •.... I -- _....__�_... - .....---- ••-- ....... -- t -- � Via:------- - - . _...... Final Inspection b Da e .-j ----------- SAN JOAQ IN LOCAL`HEALTH DISTRICT ' E. H. 9 1-'68 Rev:5M ::• -. - s 1�