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�z FOR OFFICE USE: � APPLICATION FOR SANITATION PERMIT "..-..............---•--•............. � (Complete In Triplicate) No. l I This Permit Expires 1 Y Date Issued a.� .................... ................ ...... Year From Date issued Application is hereby made to the San Joaquin Local Health District for permit to construct and Install the work herein described. This application is made in compliance with,County Ordinance,No. 549 and existing-Rules and Regulations: JOB ADDRESS/LOC, TI I . -. A. ..- .......... Owner's Name ................. CENSUS TRACT ........_.•-•- ............ ...... Phone . ................ Address city Contractor-'s Nome LN�S.�e�(��'�._ .` �* �// .... ....._.License Gv~ Installation will serve: ResidenceIii-Apart mlent House Commercial❑Trailer Court ) k y H� Motel❑Other. = ..... ` Number of living units:.... Number of bedrooms .. . .---••- _ arbage Gr rider ..... Lot Size - Water Supply. Public System and name iGf � .................. k ............................ .:.......__.... ' .....Private ❑ Character of soil to a depth of 3 feet: Sand t7 Silt❑ Clay p Peat❑ Sandy loam. ❑ Clay i.oam ❑ Hardpan(j Adobe JZ� Fill Material ............ Ifr type es `i"�:;;` Y (Plot plan, showing size of lot, location of system 'in relation-to:wells;buildings, Ste. _must be!placed,on reverse side.) NEW INSTALLATION: i (No septic tank or seepage pit permitted If public sewer is available within-2-00 feet,} PACKAGE TREATMENT Liquid dep#h i SEPTIC TAMC } Size:_`. ( - r.¢J `� Compartmen#s Capacity - -0�d/Type Cig�tl EMa�terial-t. 464 O-CrrNo._ � ......_.. . . Distance.to nearest. Well . OFoundation -.-•-- ..--•• ..Z0e...... .... Prop. Line . LEACHING LINE y. , ........... " [ ] No. of lines ... Length of each line. r .. Total Length 'D' Box . ........ Type Filter Material —�---�Depth .Filter Material .. Distance to nearest: Well ...1.14N ...._ Foundation � �, a ' .....-... Property Lin ........................ SEEPAGE PIT [ ] _•*..Depth -, ----- Diameter Diameter � :, Line-------- Number -.., =3 - 'Rock Filled ,Yes Q Na x•, i Water Table Depth ....................:.. Rock Size •.•-- r Distance to nearest: Well °,` �Q ....,�D_.!l��......................foundation� : -=- - -••---. Prop. Line --- REPAIR/ADDITION Prev. Sanitation Permit ............................................. Date Septic Tank (Specify Requirements) ---:•. ---------------- Disposal Field (Specify Requirements) .............. r -...-•••--.... -•---.....-•••......... ----- . ...................................... .._•---•••......-•----•. ....... ---••................. E �. --••--......... (Draw existing anc required addition ori reverse side) I hereby certify that I have prepared this application and that the work will be done M accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin local HealthDlstrlct. Home owner or licen- sed agents signature certifies the following: - ---- "I certify that in the performance of the work for which this permit is Issued I $half not employ an 1 as to become sublect to Workman's Compensation laws of California:" p y Y person in such manner Signed Owner $Y .�' •-•--- Title (If other than owner) FOR DEPARTMENT USE- ONLY APPLICATION ACCEPTED BY -..- - .. BUILDING PERMIT ISSUED ------------ - ..- -•---------••---------•-•-•------•-•-------..,-- DATE— . . ".` 7�.,. ADDITIONAL COMMENTS ..---•-------------- - ::�'...--. BATE .... ..-----••--.................. - $ .•--......-•--------••--••----- _...... ---------------- -------------------- ---•----•-------------•--...--------....-.....--..-..-..._-:-......--*..._.._._..------------------ FinalIn ------------------------------------------------------------------ ----•_...---..Date -` .�- Eli 13 2}a 1-68 Rev. � ...................••--.. SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7L 3M