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FOR OFFICE USE: APPLICATION ' FOR SANIT/#TION-PlrltllAlT, r ttnplet�+in Triplicate! Permit No. 75. ' :.. .........-••...................... ... �;;, �._� his Permit Expi ie 1,,YOr From Date issued Date Issued Application is herebymade•to.the San Joaquin-Local-Health District-for_a.permit-to..construct Ind..Install the work herein E described. This application islmade in compliance with CountX Ordinance No. 549 and existing Rules and Regulations.- JOB egulations:JOB ADDRfSS/LOCATiOD ._--- ---•--...... �;• .........................CENSUS TRACT Owner's Name ... ........ r: ►.wss #. Phone . .} ,... 1� Address - 4 �_.. _._....��,.. City kcal ---- _. _... :,._s ------------------ Contractor's Name :.. .. ..5._..... Cleanse # f:3.�}3 Phone�f�.�i! �a.��z Installation will serve: Residence Apartment House J-] Commercial OTrliler Court f .' Motel ❑Other Number of living units:...... Number of bedrooms ...:�----- ;. Garbage Grinder . .... Cat Size ..�l.��.l.�.:.......... . Water Supply: Public System and nameLe a� 4....-Private ❑. Character of soil to a depth of 3 feet: Sand El Silt 0 Clay 0 POW-0- -Sandy Loam 19 Clay Loam Hardpan❑ Adobe 0 Fill MateflaL ....... lfyyes,type............... ....... l (Plot plan, showing size of lot, location of system In relation to welIs,tbuIldiings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public s7werJ6141 ailable within 204 feet,) tr PACKAGE TREATMENT [ ] SEPTICTANKS€ze_....J._. .�--._ # Liquid.Depth .� . ... .... [opacity .__-•- Type -•-- Material.--- -• _ } �No. Com artntIents �_ '~ �1 1 p .................... Distance.to nearest: Well ....--- Foundation ....lb__...___.... Prop Line ...T....�:...__._^� __- LEACHING LINE No. of Lines ..---- Length of ch line___..-. �_ .. .. Tata! length ...�ZO. ..:........... � . .- a t ©' Sox Depth Filter Material �" TYI Filter Material ,. ... .. ......� ..............{t'..........Distance to nearest: Well -•------•_-_.r. ...�. Foundation .__-_ .._?I`...... Property Eine ..... .......... SEEPAGE PIT I Depth .....�{�-----_-.. Diameter x .�-- Number _._.._._. .. to . --... Rock Filled Yes No Q. ._.....�..... It !s r Water Table Depth ....................................Rock Size. t. .�--•••-•. --- Distance to nearest. Well ........................................Foundat€on f .(f.__-- Prop. Line ................. C j REPAIR/ADDITION jPrev. Sanitation Permit�# ..........-............ ----••--•--...-------. Date ..--------._._....-•---........... } o Septic Tank (Specify Requirements) --•- -------------------•-----•-- _........._....... - ... ......__........._? t J Disposal Field (Specify Requirements) -. I -- ------f-------- --- f-------•...................... ---•----------- ---- --------------------- ----------------- --------------.............................................................._............................. IDra`w existing and required addition on reverse side) I hereby certify that I haves ti pared this application and that the work will be done in accordance with San Joaquin j County Ordinances! State Laws, and Rules and Regulations of the San Joaquin Local Heal&Distrlst. Horne owner or licen- sed agents signature certifies the following: "I certify that in the performance of theAtwork for which this permit is issued, i shall :not employ any as to become subject to Workman's Coerson in such manner ompensation laws of California." Signed ----- ------- Y -- ------------ - --- Owner By ------ ` ---••-------- Title._- (if than owner) __-------- FOR DkPAR3MENT USE ONLY APPLICATION ACCEPTED BY ----- 7 �`` -DATE ._._._.q. .�.. �. ....._ ILDING PERMIT ISSUED --------------------- -DATE .- ---- ------------- ADDITIONAL COMMENTS .. _.---------_- C ------------------ : ::::::::::::::: :.:.:::: .::::::_::::::::: ----------- ::::::: --- ---------- ---- ---.... _ -------•---•--------------------------------------- __.. ._.._ _ __ --- --..... .............................. ......... Fnaf Inspection by: .... . .._..Date -•- EN 13 22t 1-6fi Rev. - �..... . .... .. . ..... SAN JOAQUIN ,LOCAL HEALTH DISTRICT 8/7h 3M