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FOR OFFICE USE: APPLICATION POR SANITATION PERMIT :.....................:..............:............I...... [Complete cate in Tripli ) Permit No. .7..5. __ .4.� ................ ........ ............ ......�IM.. _ --� " ~Date Issued ._ _. :.. .sem . .....................................I........... This Permit Expires I Year From Duh Issued Application is hereby made to the San Joaquin Local Health District for a permit to con`trtic#,and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/€OCATIO ....7`��.'o.... - � ` ...... ......................................CENSUS TRACT .......................... Owner's,Name _.. .. .... ...-•-•- Phone ��--�6 Address' ....F�_lj� s l ...City •--•... . ...................`.`1 .......:.. License #` .... .._._ Contractor's'Nome ....i x2 3.__-_ Phone .x14 :__ 17-- n� Installation will serve: i Residence Apartment House f] Commercial j]'froiler Court Q Motel ❑C}ther ..............................:........ Number of livingunits::,_I..___... Number of bedrooms -_.I...Garbage Grinder ...,........ Lot Size .....1... -1��,....1 !r1... 3 4� - Water Supply: Public-System and name .................... -- - ---------------------------. _............_...................-.......Private Character of soil to a depth l' fee4e Sand 0 Silt.0�Ci�Q Peat Q Sandy L rh Clay Loam . . \R Hardpan❑—A�dobe 0 Fill Material ............if yes,,tYPI e............... ............ (Plot plan,,showing size of 'lot, location- of syr#em In relation to wells, buildings, etc. must be placed on reverse side.] NEW INSTALLATION: (No septic tank or seepage pit permitted-if-public within 200 feet,j if PACKAGE TREATMENT [ SEPTIC TANK - ize.,... .................... Liquid Depth ................ Q pacitY,f _-_-. .._. Type .. .... . :...... Ma#erial____��' <<�:--- No. Compartments .....L............ Ditl / .......... stance.to nearest: Well -___-. ---T."`._..........Foundation ...l�..f:........ Prop. Line ... �f' LEACHING LINE [� Nlc. of Lines ..••... ............ Length of eacb line........ ....r---....... Total Length .... TO.�....__.••_-- � --t- Yi, 'D�' Box --...-L�Type Filter Material -,". .. .i..... Depth Ifilter r Material ...........1 _11*..__.--__....._....._.. 00 ! Dr's#ante to nearest: Well -.-..l. ..t...... Foundation _..---.%Q:._f_-.... Property Line .... ............... O SEEPAGE PIT Depth -_--® Diameter _ __.__. Number ..........y....._..... Rack Filled Yes No QZ I........ . .. .. rr ' Water able De Y r Table Depth _.........................�-------------.._.....Rock Size: : .�. _. ?-----...... Distance to nearest: Well _......�Q .- ......... .1......Foundation .. ...... Prop. Line .. .....+ __...... 1�� I 1 REPAIR/ADDITION{Prey. Sanitation Permit# ........................•---------...-__---- Date ............-....................._.} SepticTank (Specify Requirements) :.._.....-------------•--........--- ................. ......................._..........................I.......... ................ Disposal Field (5 pecifyRquirements) •s. s-r= ---•----•------• ......................_................ l I (� ----------------------------•• •__..---- --• - -. [ � �.. IIDraw existing and required addition'on reverse side) I hereby certify that I hays prepared this application and that the work will be done In accordance with San Joaquin County Ordinances, State ,Laws, and Rules and Regulations of the Sun Joaquin Local Health:Dlstrict. Monte owner or licen. sed agents signature certifies the following: r 16 1 certify 1gat in the performance of the work for which.this permit is issued, I shall. illot employ any person in such manner as to become subject to Wf'f rkman's Compensation laws of California." ; Signed ...... ------•------------ -- -�`1�... ------------. --. --- -•----...... Owner B _ _ � � I Y ----- ••-•-....-•--- Title `. ---------.------------------........_......... (if at an owner) r ' II. FOR DEPARTMENT USE ONLY u , �• APPLICATION ACCEPTED Y _.. y "- - --- .-------- --'- DATE .ate � � -------------------- BUILDING PERMIT ISSUEDI�--------------- ........---- -----------------------DATE _..---------------- --......__..-- ADDITIONAL COMMENTS:1.._... ............ •------------ ----------------'M .........................------------------ __ . Cl t __ .. ........................ ..... ...... ........... ...._.. Final Inspection b i. '` .. .. ��-_. P Y� ----- �II " -- -- - -• -• � - ------------------->---._...............---•---.------ ----------Date .................. ' IIi 13 2L 1-613 1 SA JOAQUIN LOCAL HEALTH DISTRICT $/7h 3M k