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FOR OFFICE USE: - APPLICATION M;g SANITATION ....... PERMIT -- -..i_ - I_ -• - -- 1CO=mpl tein Triplicate) Permit No. .-----••-- .......... This Pe,.-mit Expires f Year from Dal*Issued Date Issued Applic&ion is hereby made to the San Joaqu;,n Local Health District for a permit to construct and install the work herein describes.This application is made in corn--,Mance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESb!LOCATIQN . I.5-�6_�. 'rA., ,M< / _.. CENSUS TRACT Owner's Name ?yir t: h Address City :+ Pone . Contractor's Name-._._: =:y?�G�y'--, _ - S. �.............license # .� S ..—. . --- Phone . ........ _ Installation will sere: Residenc* Apartment Housef] Commercial❑Trailer Court M-�tel [I Other Number of livingunits:_.._..f_-_._ Number 9 ��_ \ of bedrooms "..__-Garbage Grinder ...-.._._..- Lot Size ...............:....... .. Water Supply: Public Sjisiam oixi niame --------------- ---••-----•---------_..----•-------------__--------•-----•-------....----- -- . ..__Private Character of soil to a depth of 3 feet: $and❑ Silt[jClay ❑ Peat[-] Sandy Loam Clay loam ❑ Hardpan❑ Adobe❑ Fill Material ............ If yes,type............... .. (Plot 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 -----_---.... liquid Depth X......................... Capacity ./.&'e)..... - Type Material_._ '��t' ' No. Compartments :_.-.....--- Distance to nearest: 'A-11 _ ..... ................Foundation -----IV/e... Prop. line - LEACHING LINE [e No. of Lines . .... .3------.----- Length of each line._... .-.__ Total length •- 'D' Box ..--�- Type Filter Material _.-. .........Depth Filter Material _...�%..� ...................... Distance to nearest: Well ...... :---- Foundation -..../.L' � s� ��.._-.._ Property Line ......�............. SEEPAGE PIT Depth _ -- Diameter 11:9_ ( - ----- Number ........_. Rock Filled Yes No Water Table Depth ----------------/ .4e .-------Rock Size .�1 ..� ....._ Distance to nearest: Well __.... �'. Foundation .._� Prop. Line .. ._--- RI PAIR/ADDITION(Prev. Sanitation Permit# -------- ----------------_---------- ..... Date -------------••-•--.............. Septic Tank (Specify Requirements) ---------------------------------------- -------------- Disposal -------_ _Disposal Field (Specify Requirements) __________________ --------- ---- ------ ---------- -------------------------- ------------ (Draw existing and required addition on reverse side} I hereby certify that t have prepared this application and that the work will be done In accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ..._............. Owner By - . .--- .... f�12 1'1/.� _z:E __......-- Title (If other than owner) OR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY . - 2 DATE ` 3 --- ----- - --- - BUILDING PERMIT ISSUED ....._..... ---DATE-- -- - .............. ............ COMMENTS -- - ------- - .... ...... --- -- . Fina Inspection by: . L� -. - - -----.....-- - _..Date ..`z.. ........ . . Eli 13 2t, 1-68 ltev. ,c,M � - --. . SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M