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FUK OFFICE USE: APPLICATION FOR SANITATION PERMIT ........_......... Permit No. ..7�'.. .. ... (Complete in Triplicate) i� ,7L --.. ..... ................ This Permit Expires 9 Year From Date 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. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ... ...9CO( ...AEL 1SLAN1�..... fitV�.1'.. ..... CENSUS TRACT .......................... Owner's Name n/ 1 �` .. .....Jf. one Address .......P' vi .....�ex.........34 3 .................rCity .... 577-5.&..`.....Ph....._...._................................ ... Contractor's Name .......Q.%vM. .EK license ....................... Phone .............................. installation will serve: Residence❑Apartment House Commercial❑Trailer Cam C Motel ❑Other............................................ Number of living units:..... . ...__ Number of bedrooms ....,,z.....Garbage Grinder� Lot Size .AC�'!_L26.&�................ Water Supply: Public System and name .................... ....private Character of soil to a depth of 3 feet: Sand D Silt❑ Clay ❑ Peat❑ Sandy Loam Clay Loom ❑ Hardpan 0 Adobe❑ F611 Material t'Its'.. 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,) i�11 t� PACKAGE TREATMENT [ ] SEPTIC TANK Size..' x( a__x.........t . Liquid Depth ...7..Q..............� Capacity I................. Type �i� c T Material.C ?.!J!A.1No. Compartments ....... ..........-- A Distance to nearest: Well .....:J p......................Foundation ...10...*.:7t... Prop, line ... ..,. -... EACHING LINE [ No. of tines d r ....... ...........•--. .Length of each line.......[lt�............ Total Length .......�. ��........ 'D' Box �5 . Type Filter Materlal R. ....Depth Filter Material Distance to nearest: Well ...r? ............ Foundation ...... 2 ............. Property line .....:�1............. SEEPAGE_^. PIT [ 9 Depth .................... Diameter Number ............................ Rock Filled Yes ❑ No � Water Table Depth ................................................Rock Size ................................ D le Distance to nearest: Well ........................................Foundation .................. Prop. Line ..................... REPAIR/ADDITION(Prov. Sanitation Permit# ............................................ Date Septic Tank (Specify Requirements) ......................................... .. .................................... ........................... .........._.............. .� Disposal Field (Specify Requirements) .... �� r.71�.E: .i ,......,�1�:zi—r•......hZI.I ..i.l -•............... ------............................................................................................................................................... -------------•-----•--......... J -----------..................................................... (Draw existing and required addition on reverse side) I hereby certify that 1 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 perfor once of the work for which this permit is issued, 1 shall not employ any person in such manner as to bec subject to o man's Compo sution laws of California." Signed ,4 !,/ ..._..._.. .. . Owner By ..... _...... ... ??c"� tZ'... ZA.. .. ��.. ...... Title ..................................... (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----- - (. `. 1........ ........................................................... DATE ......-3.:.�.�.' BUILDING PERMIT ISSUED ....... .7 ."' ADDITIONALCOMMENTS ...........__...... .. ....................................---............ -- --------- DATE .. . ......... .....---- / / ..... . .. ..... ................. Final Inspection by._r _........ ._ . ..�lj_ ...` _,............. .............Date .. Eil 13 21, 1--6A lay. 5ai ..-_..._ ... •-• ------.... SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3N