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FOR OFFICE USE: APPLICATION/FOR,SANITATION PERMIT .......... •-•••................ $ (Complete in Triplicate) Permit No. This.Permit Expires 1:Year From Date Issued Date Issued Application is hereby q 1, pp y made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 544 and existing Rules and Regulations. JOB ADDRESS/LOCATION 5� (26rebN f} -- --------------._.__...._,. _..........CENSUS TRACT ., ...... ........... Owner's'Name :. . .Zj!t f�__. # ..........: Phone '—3SS� Address . Tfti� st�z K1.: s I... -. ^!o�?Rw City ...__.. V� Contractor`s'"Marne .::_:.__. 1{1 �2'fS .-- �N S i :... ....._...: `T ?!S Installation will serve: Res dente` Apartment-House Commercial :i]Trailer Court i[] Motel C]'Other _. ' .. .... i Number of living units:_..:..._ . Number Of bed ams , Ga ._ rbage Gririder,l_.____ ._...Ilot Size; . .. Water Supply: Public System and name ._.._�.?- a-e� : .. -= = =.;.. �.. Private ❑.,.. -.i i•of soil to a depth of 3 feet: Sand 0 Silt❑ I�.� Peat❑ Sandy m Characte Clay Loa Cray Loam �] Hard an Adobe (g] Fill Material If yes;type _ p _: .< - (plot:.plan, showing. size..ofJot, location of system in; relation.,to.Wells, buildings, dtc' must,be,placed on.,.reverse,aside.) NEW INSTALLATION. . {No septic tank or,seepage pit_permitted if-pub fir s er isavailable within 200 feet,} " �I PACKAGE r TREA,..TMENT SEPTIC TANK 'Size.................... F .. _.I.....-- L.i.qui �e • th . ., ..p Capacity ............. Type ...:................ Material----.:.. ._...-- ,. ..; ---- Nompartments; --- Distance to nearest: Well ....................................Foundation . i y Pr _ _ --- Prop.-Line � LEACHING LINE [ ] No. of Lines , Lengt of each line.1,1._i € Intatllert th 'D' Box _.:--'------ Type Filter Material g r� . :Depth Filter Notarial _----• ......:..::.. ' Distance to nearest: Well ......:......... Foundation ._::-_-:•' ••------::.-- p rty . • . 1 1 1 µ •' t Pro a Line _........ _. SEEPAGE:PIT .(..), Depth. .... DiameterF- ... Number I R odc Filled' Yes � No Water` Table Depth -- __•--.... ... --- .. _Rock Size ... Distance to nearest: Well _ i ... --•- ---•------- . .Foundation ' Prop: Line -. . REPAIR/ADDITION{Prev. Sanitation Permit,# ............. .Date Septic Tank (Speci ..................................... ., ! Requirements) ••.... ......... •__•____ .....1_......................»-. ._{o C ! Disposal Field •(Specify" Requirements) ,,..--- --- 0�•-- ... ... _-v`q5_._ //''8 r�7C v�:�� ,,`-_I ... ,� ._ _ ..... -- ---.----- ........ 4 . (Draw existing and req'WQ,a'Uditioro on reveiseiside)k - 13 hereby certify that I have prepared this~application cncl that the work will.:be done in'ace' rdance with San Joaquin County"Ordinance3, State ;law's, and Rules and Regulations of the Son Jo'aquinj, cal Heal#h District. Home'ownsr -or lies agents signature.certifies the foliowin ti . g.; } ".1 certify that in the p"erformance of the, work for .4h!cfi this permit is issued, I'shall not employ any `person insuch manner a`,s to become subject to Warkn 's Compensation laws of California. ft # , Signed < .. -••...: ......... - Owner .� :.. Bye Title -(If other than owner) `FOR EPARTMENT U E,`ONLY�: r APPLICATION.ACCEPfED BY . :..__ M-1. ...._..... DATE ... �. �...:. BUILDING':-PERMIT ISSUED-__-, :•-•-•-•.;......_ , ......... .....: ...... ................ ...DATE ADDITIONAL COMMENTS ................. ; - e __ _.. ..._-. ..: _ _ .... .. .. ... .......- Final Inspection by t .Dae SAN JOAQUIN LOCAL' HEALTH DISTRICT L3 24 E. H. 1.'68 Rev. 5M