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FEAR OFFICE USE, - t APPLICATION FOR SANITATION PERMIT X03 ..:........:.....:.. ... ..... ..1 ............... (Complete in Triplicate) Permit Na. ....7..17... .... This Permit ns y Y Date Issued .g—. t .. Expires Yew Brom Deft)::hand Applkation 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: JOB ADDRESSAOCATION ..._ ., ._ .� ......., &Zr—.Al.... .. .... . .. .... .. ...Cts TRACT ...... ............... Owner's Name ---......... c�t'�,l'rzt�1. .........,. ... .... .,'....,*......Phone .................................... Address . .S.�Q/'Yl.L.-....... .. . ... . ................................_................ City ..,E4.........,......+ ........ ........I...... Contractor's Name __ ,/,7 �. SPG ,e.H.... A--. . . .............License# -kvs;?�.4..... Phone Installation will serve: Residence O(Apartmsnft House 0 Commercial QTralter Court 0 Motel Q Other Number of living units:.....�. Number of bedrooms . .....Gairc+ s Grinds ............ Lot Size .... �......- Water Supply: Public System and name ...............................................................................................................Prhratbe Q Character of soil to a depth of 3 feet: Sand 9 Silt Q Clay Q Peat Q Sandy Loam Q Clay Loam O Hardpan Q Adobe 0 Fill Materlal............If yes,type.............. ............ (Piot plan, showing size of lot, location of system 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 TREATMENT [ ] SEPTIC TANK{ I Size.............................................. Liquid Depth.......................... Capacity-19-0-0..... Type MaterialCtA1.114. .. No. Compartments .24. ............ . Distance to nearest: Well . .2--0. ......................Foundation .4EGt............ Prop. Line...14-�- ...... ... S LEACHING LINE [ ] No. of Linea _..,) -- ---- Length of each line ...Za..Q..� ....._.. S ----... ... . � ....... Total length 'D' Box .../:..... Type Filter Material ...1.. .. ..Depth Filter Material ....../.`c3' ............................. . Distance to nearest: Well .... ......... Foundation . _,,t`_-0�.......... Property Line ...J� .... .... .... ... 66SPAC444T ( ( Depth .•-1- .. . Diameter Number ........ .............. Rock Fitted Yes No 0 To'"? Water Table Depth ................................................Rask Size .. .................... Distance to nearest: Well .. . .....................Foundation .10-0. ...... Prop. Line ....39 ...... REPAIR/ADDITION(Prov. Sanitation Permit# ........................................... Date ..................................} Septic Tank (Specify Requirements) ........................................... w.............•---.....--.:. ......._ ..... Disposal FWTd (Specify Requirements) ........ ........ :................... .................•-- •---- .................................................. ....----•------••....................•--...--•----•----.........--•--...---............... ...--- ....._... ................... ..----................._............._........................... (Draw existing and required addition on averse side) I hereby certify that t have prepared this application and that the work will be done in accordance with fan Jowi� County Ordinances, State Laws, and Rules and Regeletiens of the Son Jeo quip Local HeaW Dktrld. Nom e, owner or New sed agents signature certifies the following: "I certify that in the performance of the work for which this permit Is issued, I shalt not employ any►person M sech manner as to become subject to Workman's Compensation laws of California." Signed ._ -. Owner ., rel 8y ...... .. te,�,�.-....... . ........ ....... ............... title .... plleut" (if other than owner] FOR MUTM841, USE ONLY �<.�.. . ..... -- --• DATE ................ APPLICATION ACCEPTED BY:..__--a� `.'. _.f-- G.". ..... ......... ........... BUILDINGPERMIT ISSUED .......:.. .... ............ ,................................................................DATE .- ................................. ADDITIONAL COMMENTS .._,.. _ . ,/ ............. ................................... .....::� :._ L. ext,) ................ ............................. Final Inspection by: ... .--i.44Date . ., ... ........... FH 13 24 1-68 Rev, SAN JOACIUIN LOCAL HEALTH DISTRICT 8/74 3M