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FOR OFFICE USE: APPLICATION ICOR SANITATION PERM . _ tCompl+eb M Trlplicahi Permit .. t �`'� ... ........................... �`.`�'.........._..... This Permit Expires 1 Year fromDatelsss" 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. 549 and existing Rules and Reguiotions: JOB ADDRESSAOCATION �V.3 I„XIL CENSUS TRACT ................ .._.. Owner's a e .....__. ... i ....... _... ....................................... Mone` .7—., �f' Address -.!�!.. .. --•- ------•-/ il._ Gr+!-�' /2Lcity .... .... ....._ .-•-...... Contractor's Name L2 o. ------------------ --lbrsnse# /�� .�.... Phone Installation will serve: Residence)j Apartment Hwsefl Commercial QTrallw Court 0 MotelQ Other............................................ Number of living units:... Number of bedrooms ....y.Gcr a Grinder ... Lot Size ............... Water Supply: Public System and name .. ............._.._..,.............. .. ..>L... ..._........... .......,........... Q . .• .Private Character of soil to a depth of 3 feet: Sand E Silt Q Gay [j Peat❑'F Sandy loom❑ Clay Loam Hardpan Q AdobeFill Material............H yes,type............... ............ )Plot plan, showing size of lot, location of system Id relafion to woffi, buildings, etc. must be placed on reverse side.)(,V NEW INSTALLATION: (No septic tank or seepage pit.-permitter itvpublk sewer is available within 200 feet,) PACKAGE TREATMENT [ 7 SEPI TANK{ ] Size ' .. ....: Liquid Depth Capacity .................... Type ............ N ►trerial...................... No. Compartments ................. Distance to nearest: Well ................. ..... .........Foundation ...................... Prop. line ...................... LEACHING LINE ( j No. of Cines.:....: ........ ...... Length of each line............................ Total Length ............................ 'D' Box .... ..w;. Type Filter Material ....................Depth Filter Material ............................................ Distance to nearest; Well ........ Foundation._. ',_...... F ............. .......... Property line ...................... SEEPAGE PIT i ❑ . _ [ ! �'..................... Diameter, --.....�--......, Number --.......... Rock Filled Yes No Water'Tvble Dept ...............................................Rock Size .............................. is istance to nearest. Well ........................................Foundation .................... Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit --------------------------------------------. Dale ..............:..................... ) Septic Tank (Specify Requirements) .......................... ........................ ........}........... _... ............... �J Disposal Field (Specify Requirements) ...... Lz �.......-- .-cCr4-rrx ........................... .....-------• ............................----- ---' .... .........•Q !/.... ... . ........................................... ............. (brave existing and required addition on reverse side) I hereby certify that 1 have prepared this AWIcation 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 HeaMM District. Home owner or llcen- 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 -------- - -- -- ------ -�----- ------- ............................... Jitle 46� "- ... . ----------- ------ ----•------••------ (If r than owner) FOR DEPARTMENT USE ONLY APPLICATION AC EPTED DATE .-..oZ.: 3.�T .............. BUILDING PERMIT ISSUED .... .......... .................................................... ...DATE ... ...------•-•--......... ......... ADDITIONALCOMMENTS - ............................ ...................... --_--.......--- ......................-... ................ .... ............---................... •. ......_..._._ .................. .......-.................................................. ------------� .... --- --------- --•---- •------- ----- ............................. ......•---•--••-----------------•- -t...._. _. .... - Final Inspection by: .. �=� •-•- ......... ----------------•••.--••------........._...I...............Date 7---v.�..-'- ... ..... .......... EH 13 2h 1-68 Rev. � SAN fOAQ N LOCAL HEALTH DISTRICT 8/74 3m d �, a �&Z4 4 k ,�i�-