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FOR OFFICE USE: .. AMICATI I .......................r-,7 /� _ ON FOR SANITATION PERMIT �J+. — ------�S. Perm it No. �....:...... rr lCornplite in Trlplicatsl -••---•-••••-•-•---- 1. ` u•u- .................................. Permit From 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,mode-in-complionce with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION lk t •----•--•- ----- ------ .............. Owner's Name --------•- CENSUS TRACE .. . ... _ ..:.. Address _.... . /:- y -• ;-- .•...ry..... .. . ...... -.c.f.._Phone ---•---- •--------- , '; 412 Contractor's Name•------------•-- -- I -------- ....Liognse.. = Phone Installation will serve: Reside ce'�tApartment House Commercial O`S 0❑ ❑frailer Court Motel ❑ ; Other:...:._..�._...._. •��x # Number of living units:__. Number of bedrooms" J0 ...._Garbage Gr rider h . Lot Size .,� Wa#mer Supply: Public System and name ---.-----_ _ _ roil-- ..._-1-..............Peat ��_, y .................................Private ❑ Character of sol!#' a depth of 3 feet: and Silt 'T� ! I Y ❑ ❑ Sandy Loam ❑ Clay Loam ❑ Hardpan Q Adobe fill Material ............ If.yes,type............... ............ # ; Fs # �.. rn` t (blot plan, showing size of lot, location of•systeiriirelatlon to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: {No;40ptizt4f nk�or seepage pit permitted if�,public sewer is alailab#e within 200 feet,) PACKAGE TREATMENT f I SEPTIC TANK ] t Sze..:....... ............................. _ . Liquid Depth Capacity ------ .. No. Compartments .. ............... ` Uistanre.to neprest:�.` ~: ~t c --nsores. Well - ------------...................Foundation' .. Prop. Line LEACHING LINE [ ) No. of`Lines � � qth. of line_. _ _ ................'.. --.-- ---_ .... Total Length 'D' Bax . _..:...,_...Depth Filte :.. � ---------... Type .Filter Ma#erial --•-• Z . � � �r Materia! _._....------•----•------------------------- Distance to neare�rst:+.Well ....... . foundation Property Line ....... EEPAGE PIT ( ) Depth ....................th Diameter .. Number .............. ............ Rack Filled Yes ❑ No Water Table Dep — - .d. ...................................Rock Size . Distance to nearest: ` Well -----•----•........................... :Foundation _. Prop. Line REPAIR/AdDITION(Prev. Sanitation Permit a# Date .. .---••.............. ) Septic Tank (Specify�itequirements) r. " ................... ---- - - ' Disposal Fief (Specify Aq.ui'rements) ---- ---------- --_ .Q --- u r , Z ----------------•-•-•--•-•••--...........-•--• ---------••-- 4�--•-. (Draw existing and required addition on reverse side) ............. .................... .::.. f ! hereby certify that 1 have prepared this pp,plication and that the work wili be clone in accordance with San Joaquin County Ordinances, State taws, and Rules and Regulations of the San .loaquifecal 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, 1 shalt not employ an ' as to become subject to Workman's Compensation laws of California." P y y person in such manner Signed ------- Owner I ---•------------- -- title - (if other n owner) � ...---• ----------- ------------••-� --- tF t ,A17 NT F1 1! ONLY APPLICATION ACCEPTED BY --- -------------- - ------- ---------- ----- _ ?f BUILDING PERMIT ISSUED ..---..._.. DATE ...._... 1 .,, E ADDITIONAL COMMENTS ..-__.---............... ------------- •-.--•• ------------------DATE ------ ------------ .. ------------ ----- ---- Final Inspection b - � ............ ..................... py: ..---------- ._. - ---------- EH .. EH��+.{{�� } L[} � -��/ --- -- •---------•--------••-•----- ...............--...................-----------bate --.---fir. o � (--�- 13 2b 1-613 lil:`rw - /.-_.._.. �.? .. .... SAN JOAQUIN LO L HEALTH DISTRICT 8/7h 3M