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.0 I FOR OFFICE USE. .."'•.••` APPLICATION ICOR SANITATION PERMIT (;Complete in Trlpltcate) 0ermit No. .:.:3y... r ................ ......... This Permit 1 Year from pati lSSW& d .......... ... Dote Issue •5_ .� Application is hereby model o the an 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. 549 and existing Rules and Regulations: i y JOB -ADDRESS LOCATION .._ 6.3_ tr r. Owner's Name- - �+ .-s�-►.r- vf.:.... - Phone CENSUS TRACT . .. Vi7 Adder _.. .,C......... s ' ity Contractor's Name h 7 --- --f------ est .-.... .. f v:t` ...... License� ...� Phone . f�lf Installation will serve: itesidence 0 Apartment House❑ Commercial TralteI Court Motel btOther.. ;..................................... Number of.living units:_._..._ _ Number of bedrooms .._:.._...._Garbage Grinder Lot SizeaF - Water Supply: Pub#ic System and risme -�-a•. ..•. .__:, '�,� -. �;,,;. ....-----�....................... , -----••.....................•--.......... ......�__.. :_......._.........•-• `•---- .........Priv e Character of soil to a depth of 3 feet: Sand Silt ❑ Clay ❑ Peat❑ Sandy Loam.[]`' 'Cloy Loam❑ Hardpan p Adobe ] FII(M6teral .........:.:If yea,tYPe•.............. (Plot plan, showing size of lot, location of system In relation to wells, buildings, etc, must be placed on reverse side.) Ni:W ANSTALLATION: (No septic tank or seepage pit.permitted if public sewer is available withinY200 feet,] PACKAGE TREATMENT [ ] SEPTIC TANX I ] Size................----.........___.........:.. Liquid Depth ........................._ Capacity •- ---•------ t Type ....•.--••----=--•-- Material...................... No. Compartments� -•--•• Distance to nearest: Well Foundation--•----- ----- ---------------- Prop. Line ...................... 6 LEACHING LINE [ ]. No. of Lines ----------------------_ Length of each #i e.. Qz, Total Length.___ ...;:�;�;-.... g •-•--•----•................� 'D' Box Type Filter Material: Depth Filter Material _..-• .. Distance to nearest: Well ...............•--...... Foundati'on'..._. :_._---------. Property Line ..... SEEPAGE PIT Depth ----- Z -----•---- Diameter -------------- Number ----------_---------------- Rock Filled . Yes ❑ N ❑. f Water Table Depth .Z Rock Size,e-.:,............. - Distance to nearest: Well ..Foundation'`.._-.................. Prop Line ............. REPAIR/ADDITION(Prev. Sanitation Permit i' 4+ .. '# Date ----------------------- -------- Septic Tank (Specify Requirements] ................... Disposal Field (Specify Requirements) --•-----•-- ,11 / - ----------•----------- ---- �:�. • _T t ----=------- - =- _ (Draw expisptinr and required addition ----......- g q on reverse side) - - I hereby certify that 1 have prepared this„a Nation and that the work' will be done In accordance with San Joaquin County Ordinances, Slate taws;' aced RulesantiRegulations of the San Joaquin Local Health:District. Homo owner or licen- sed agents signature certifies the following: � . "I certify that in the performance of the work for'which this permit Is Issued, 1 shall not employ as to become subject to Workman's Compensation laws of California.” p . y any person in such manner Signed -- ------- -------- Owner BY --- --- --- =-- ----- - ---"---.. _._.._...---•- ------ x.itle ---- • - ------ - (I than owner] ,. F _.--�� Y - . _ FOR DEPARTMENT USE ONLY r APPLICATION ACCEPTED BYBUILDING DAT ._,._ - DATE _..:.- .. ---------------------------------- ----------- ` ADDITiQNAI COMMENTS .. .l'_�. ------------- ------•----•----= PERMIT ISSUED ---------•- --- --------------- _--- -•------ --- ........................................... ' --- , - Final Inspection by: --- �__.. ------- - , ------------•-•------- ----------- ' - f /.-�.. - - ---•- •-•- - -• --._. .. ..... �_._��...�.� EH 13 24 1-68 Nev. � ��r�r�_ -. � ----- � SAKI JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M