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FOR OFFICE USE: AfsPllCATlON f�Oft SANITATION pERMfT ............. �. (Comple►te In Triplicate) Permit No. . ............................. Thin Permit Expires 1 Your Prom Date Issued' Date Issued: Application is hereby 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. 549 and existing Rules.and Regulations: g0 E. 8 Mile Road . Gl 108 ADDRESS/LOCATION ..... 4.............._....................•-•--...............:......_................................CENSUS TRACT .......................... ' Owner's Name 9&1en We 1 ch ............. ......_...---..............................................................................................Phone ..................................:. Address .................. --........._... ...............City .........St•o(,—kton............................................... oto Rooter S wer Ser. Contractor's Name __ e......•.....-._---- ..License 96E' ..;�Z1539...... phone�:6�-2616-...:..._. Installation will serve: Residence 0 Apartment House Commercial OTraller Court 0 Motel 0 Other-----1_ t-rald,ex............... Y Number of living units:... Number of bedrooms �..........Garbage Grinder .. .. Lot Size ... ...fort. of b acres ........ ........ Water Supply: Public System and name ....Private --•----------------------- �.•.....--•--................................... Character of soil to a depth of 3 feet: Sand 0 Silt 0 Clay 0 Peat 0 Sandy Loam 0 Clay Loam 0 Hardpan 0 " Adobes] Fill Material no....... If yes,type.—........... ............ (Plot plan, showing size of lot, location of syste7rh in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREAThAENT�f-], SEPTIC TANK 5ize... 4 by 5 by. 9 Liquid Depth .....: ....:....... ...� - —f Q i. Capacity ---- Type ...Pre__c as Material.c onere to No., Compartments ..... Distance.to nearest: Well 100...........................Foundation ...................... Prop. Line .................... LEACHING LINE No. of Lines ......... Length of each line------. Total Length ...... t 'D' Box ..yes... Type Filter Material .-rock Depth Filter Material ._.... 81}.. 5-1 Distance to nearest: Well .:._ e0_.. ....__ Foundation ................._....... Property Line ......................... SEEPAGE PIT-Tkj-"—Di;pth .25_'............ Diameter ................ Rock Filled Yes ® No (3 Water Table Depth ------------------------------------------------ 851 112,Size -------------------------------- Distance ---�-2--by-•------------ P. 100� , Distance to nearest: Well ................. ...Foundation ....... 0:'. Prop. Line ...... REPAIR/ADDITION(Prev. Sanitation Permit# _.............. Date............................:.-•__}. Septic Tank (Specify Requirements) ........ . Disposal Field (Specify Requirements) ----------------•-------........--•--•-•--••-•---...... ..... ........._.............•---------------._:........ ...... ................. . - ........ .............. .......... ........... -. .---11......................._..:...................................... ----------------•--------------•---------- _ __.-------•-•---•-------•-•----••----•--....---.._............:-----...._..........._._._...... 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 San Joaquln County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Heafth:District. Home owner or licm sed agents signature certifies the following: 4 "I certify that In the performance of the work for which this permit is issued, I shalt not employ any person in suchmanner as to became subject to Workman's Compensation .laws of California." Signed ---------- - Contractor -------------- Owner j k t I By ----------tir ................. Tit a ---------- ---• ------------------------ --------------------- jl of er than owner) ' A FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----- ------ • --- - •- ....... DATE BUILDING PERMIT ISSUED .... --------------............ ....•-r.. _..--------........._......._..........DATE ............. ---------------------------- ADDITIONALCOMMENTS ---------------------------------.....::---- - ` .----------.-----------------------•---- --•-• '----•--•----•----------------------------- ------------ ------- ..................r-�5m : .... ._.. . -__._ --------------........._. :---•---- ........ .._.__...... ......... �_ __ --- ---- --- .: ------•--••--•----------•- finai Inspection b _Dated.. . ..; .................... EH 13 2h 1.-68 SAN JOAQUIN L CAL HEALTH DISTRICT 8/7h 3M