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r FOR OFFICE a APPLICATION FOR SANITATION PER .............................L..°.. MIT .. (£ornpleteln Tr1plfcatsl Permit No. ..7G- 53 _...................................... w-mss -7� ..... This Permit Expires I Year From Dale Issued Date Issued ................... Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein a described. This application Is made In compliance with Count Ordinanc No. 549 and existing Rules and Regulations: I JOB ADDRE55/LCrCAT N ..._ ... ...... ...--••- :..........................CENSUS TRACT ...... ................... Owner's Name ...... .. ...... . .................................... Phone e�31 "! Address ................ .. .,�� .... ...... .................................. .!v-G4 .-....---.......:.City . ................. .......--------•--.................... Cantrattor's Name -•.......................License I:.7.f�_;�.7. Phone installation will serve Residence JM Apartment House t'] Commercial QTraller Cam 0 Motel ❑Other............._------------:- ............. Number of living units:.....f-.. Number of bedrooms 3.......Garbage Grinder ............ Lot Size Z-Q...... .. ........... ...... a Water Supply: Public System and name •............................ ...................._..................................................Private IV Character of soil to a depth of 3 feet: Sand'] Silt❑ Clay .0 Peat❑ Sandy Loam ❑ Clay Loam Hardpan❑ Adobe❑ Fill Material ............If yes,type............... ............ !Plot plan, showing size of lot, location of system In relation to wells, buildings, etc. must be placed an reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted If public sewer is available within 244 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK f ize..� ................. Liquid Depth ...-�!�............. O Capacity .Ito.0-6----- Typa6/1�. . Material ...... No. Compartments .....r —.-..r.S ' Distance to nearer!: Well" �� . fi..............Foundation .1.49 . Prop. Line :I -EACHING LINE (�'No. of Lines .......�.....--_. Length of each Ilne... s�:.. .r.. Total Length .....�.�lJ............ 'D' Box ....�. Type Filter Material 5Z&;4..Depth 1Filter-Material ..........Ze...... .....I. . i Distance to nearest, Well ..5 �............ Foundation ........ Property Line Sft...........=.... SEEPAGE PIT [ Depth ...49?-.15 r.... Diameter . ........... Number ..................:......... Rock Filled Yes ja- No Water Table Deoth .../40...........I.. •.............Rock Site . �. ....... 4 Distance to nearest: Well .. eQ.........................Foundation ..11�..sr,�-...... Prop. Line ..5..� . t REPAIR/ADDITION IPrev. Sanitation Permit# ............................................ Date ........................... SepticTank (Specify Requirements) ..........................•.............. ............................................................_........_....._................ Disposal Field (Specify Requirements) ......................................................•••......................::..................._.._.............I......---•• .................. ................................................................I..................-- .... ................_._.........-----.......................-----....... (Draw.existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be done In accordance with Son Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or Ilcen- sed agents signature certifies the following: I "I certify that In the performance of the work for which this permit is Issued, I shall not employ any person in such manner as to beco u Ajet to Wo an's nsation laws of Cali(ornia.""'�-�'"`�" , =za:nec! .. . .. . .......,... .............................. Owner !. .... .. . Tiffy ........ ..........................BY ............ (if of erthan owner) . t FOR DEPARTMENT USE ONLY l ._.... DATE ....� ..�. APPLICATION ACCEPTED BY ...... .._ .. .. _.................I.... ................. .:. BUILDING PERMIT' ISSUED ....... ....... .. ......................................................DATE-. . .................................... ADDITIONALCOMMENTS ...... _................................................. ......................•---...........__.. - ._... . .............................................. ........... ................................................... ....... :::::::::.......................... ............----........................... - .................................... . ..... .. ............... .... .. _._. Final Inspection by: ..... . . ...................................................m._. ..................Date /.d � ... : . _.. EH �3 24 1-613 aev• SAN JOAQUIN LOCAL HEALTH DISTRICT CID 8/7h 34