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FOR OFFICe USE: w APPLICATION hOR SANITATION PERMfT y 7s S tComplets in Triplicatel Permit No. ..............: :.._.. This Permit Expires t Year from Doto 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. 5.49 and existing Rules and Regulations: JOB ADDRESS/LOCAT7 .7.�. :._ ........ � .. . .. ....CENSUS TRACT Owner's Name Phone s asp/}' .._.... ...... II ................:. .................. Address - I tz.... . icy ..... . .. ...... -_...._......---._... - •- Contractor's Name ............ .. _ :_.� _........License ......_ Phone? �&07--- .... Installation will.serve: Residence OApartment.Housef3 Commercial oTraller Court C] rMotel ❑Other....... ...............:.......:........ Number of living units:...i......_. Number of bedrooms .....T...Garbage Grinder NLot-Size -• - ._ -Water Supply: Public Systems an name - = � --........_... .__ ... ._.....�___..._ i ...Private Character of soil to a depth of 3 feet: Sand E] Silt Q Cloy', . Peat❑ Sancfy`Loam fl Clay Loam Adobe � Hardpan❑ �ill��Aater`iaP ... . If yes,type (Plot plan, showing size of 'lot,location_jof. system inrrelatlon-to•wells buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sower Is available within 200 feet) PACKAGE TREATMENT I ] SEPTIC TANK ] f rze..__�` .� �rJ.. s __. . Uq ! Capacity T)pe = Materials e No Compartments nts ?� � r p istance�to-noare•st: Well ---- '! -- -..---------Foundation .�,_..A? ._. Prop. Line ......e..............� It. 4 LEACHING LINE tq\No. of Lines -----....... Length of ach line.__._...._ � Total Length -/. 4?..................lw 'D' Box --- T e .Filter Material Yp ...._.,• Depth Filtei aterial " -1 p .�' , W I Y .... Distance to nearest: Well .. ��Q...:_...._ Foundation ......./Q...-. f I ...... f roperty Line SEEPAGE PIT (Xf Depth .qe0____..... Diameter �7�.J� Number �„! -- '------- �---- -•••-•---�------ Rock�Filled• Yes,fit, No tA Water Table De`pth's --� --:�::n .Rock Size X4 �r t � _ .... 1. . .......... f Distance to nearest?.:WbII �• ��Q............ ......fou clotion ` tq Prop. Line . .•••--......--- . •fit � s--��'� � €� � ` REPAIR/ADDITION(Prov. Sanitation f ertnit# Septic Tank (S eci Re uiremen s,4 I`" l ate ---_..--••-_..--- - --•-• Disposal Field (Specify Requirementsl ....-•-• ............I_ 7S r , �d . ---•--•-•••----------- •-•-... •--- ... I ' ....... (Drawexisting and Fequiied-add'itfon on reverse s 614'11,u� I hereby certify that I have prepared this applfcation and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulc tlons of the San Joaquin Local Health,District. Home owner or licen- sed agents signature cehifies the following: "I certify that in the performance of the %fork.for.which this Hermit is issued, i shall not employ any person in such manner as to become subject #o{Workman's Cornp�e�tsaiior laws o11 California." I � r s 'S Signed ---- ........ ------- - ------------------ By Owner . .......... ............... O e Title ..._..-- ( r ah owner FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------FI - ,V -------- - BUIEDING PERMIT ISSUED __ -- --------------•-••------------ •...... DATE __:..,�:.A-,,.��_ --_ -S ......................... .DATE ---------------•--•------------------ ---------------------------Af7D#T10NAL COMMENTS - .-.. ._. _ -----•---- •------•--- --- ............•�----- ---•----.... ---------• ----------- ............... -------------•. ....--••---•-- ----------------- Final Irispectio,hAy:!__.. -- --- --- -•- - -..--- --•-----..._ _ --------------•-----�---..._._....._...._.__...------.._..._Date ....----...-----(.. .�JJ----- EH 13 2II 1--6f3 Irv. SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M