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..:4�,Fr OFFICE USE: APPUCATION R SArN1TATO N PONT 7r Permit No. (Complete ITriplicate) .. S� v .......-•................................................ This Permit Expires 1 Year From Daloissued Data Issued .6_-.21- .76 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 I compliance wi. County Ordinance Ng'. 549 and existing Rules and Regulations: y �l _ JOB ADDRfSS/L TION . Sl .�IIa... . G�, .Zc ,. [._ E JS TRACT .... . ..... ......... ........................... Owner's Name �..�J., ....... _.. ...---•-•..... ..................................................... ..� ...............Phone .................................... Address - _...._..._-------------A;4V..Ab4:?� �..0�.-. . .�--.../.?') %.�?...._...............City ...........4�'.�r.......,........................._...................._... Contractor's Name ....- .......................................................License th Phone .............................. Installation will serve: Residence[3_40i tment House Commercial OTraller Cows 0 Motel Q Other............................................ Number of living units:........... Number of bedrooms .........Garbage Grinder/Lj"&,ca. Lot Size ..................A Water Supply: Public System and name .._....._ ................._....................._....!............................................Private Character of soil to a depth of 3 feet: Sand D Slit Q Clay C] Peat❑ Sandy Loom 0 Clay Loam ❑ Hardpan❑ Adob J9 Fill Mgterlal ............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,! 11/� PACKAGE TREATMENT [ ] SEPTIC TANK f'� .�.,1Ca'.. Z.l.... ........ Liquid Depth .....7../Z.......... Capacity ...)Da.Q.._ Type F&L.. Material._ a. Compartments 2--.......... r Distance to nearest: Well ...........O..�...............Foundation ... AJ. Prop. Line . .� LEACHING LINE (j� No. of lines Length of each line. �. Total length .1.77 �........... .- 'D' Box i��4__.. Type Filter Material // ..Y'.��1.k"'....Depth Filter Material ....1.1.............................. Distance to nearest. Well _. ............. Foundation .............. Pro Line ............ l �� ' gym► ............ SEEPAGE PIT Depth • .......... • -..... Diameter ..... . .. Number ............ ............ Rock Filled Yes J�o 0 Water Table Depth _..... �..... .............................Rock Size .... Distance to nearest: Well .........C ?o... .................Foundation .....4.2..0_ ........ ....... •-•- � Prop. Line ..S. ......... REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date .................................. Septic Tank (Specify Requirements) ---.-•--------•---.-•................................. Disposal Field (Specify Requirements) ---------------------------------------------------- ••--.......... --••-....__................._.....................................................................................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 Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health,District. Home owner or !icon• sed agents signature certifies the following: "I certify that in the performance of the work for which this penult is Issued, I shell not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed .................. ........•----•........_. ....._._....... _ Owner By ----- ---•- ------------------ -- -- _. -•-.. Title .--•--- (if o er t an owner) FOR DEPARTMENT USE ONLY _ APPLICATION ACCEPTED BY . . •--- ............... DATE BUILDING PERMIT ISSUED ....... .............................. ......---...-- ............. ._t......_..........DATE ------ _--_ ---------- ADDITIONALCOMMENTS ----------- .................. .............................................. -........................... ------ -- . . ........................... Vot ------------- --- ••----•..................- • -- . ........... ................ ..•••..---•• .-. .. �� Final Inspection by: .._- _._... _......Date ... . Z�; _ // Eli 13 24 1--68 Rev. Vit' SAKI JOAC}U!N L NE DISTRICT .... $/74 3M