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sR3R::OFFlGE tlSE APPLICATION FOR SANITATION PERMIT `�J .�. ....... ..... Permit ilio. ..l..K'.:.1..�1... e ... (Complete in Triplicate) 6/)..I-\- ......_.T.._.... w _. Deft Issued This permit Expires 9 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to constnict and install the work herein described. This application is made In compliance with County Ordinance No. 549 and existing Rules and Regulationse , i. .....................CENSUS T/R�ACT .......................... ......JOi ADDRESS/ OCAT! N Ownr's Name ... . �� Address ........ .lb._.%AO .. L.V.�I....... ...........................City . "Gi�t..0 l l.............. ` ._. Contractor's Name ...... ler- ............................. License # ........................ Phone .......................... Installation will serves Residence❑Apartment House[3 Commercial❑Trailer Court Motel ❑Other............................................ . Number of living units$......)--- Number of bedrooms ...._Garbage Grinder ............ Water Supply: Public System and name . -•................ • -•-----......................._...................................................Pr ` Character of soil to a depth of 3 feetr Sand 1[] Slit(3 Cloy ❑ Peat(:j Sandy Loam C3 day Loam'0 Hardpan❑ Adobe❑ (all Material ............if ya,type............... ............ t < (Plot plan, showing size of lot, location of system In relation to wells, buildings, etc. must be placed an reverse side.] NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT I ] SEPTIC TANK //��__ Size...: ....: .................. Liquid Depth .......................... Capacity .,� . . Type P�" dxt. Material. !C/32 . No. Compartments ...-7. Distance to nearest- Well . ............Foundation Prop. Line ...� .. . ng tEACHING LINE No. of Lines/ .. Length of ea line. . .�� ... Total Length ../ .. . j 'D' Box ..... [..... Type Filter Material . .� . Depth Filter Material ...... d ......... ...... ` Distance to neareste Well .ids .......... Foundation .. � .�. ... Property Line' .4crr••• ... /40410 SEEPAGE PIT [ ; Depth ... . --........... DiameterU................ Number ............................ Rock Filled' Yes ❑ No WaterTable Depth ..--•..................................•---•--..Rock Sin ................................ i Distance to nearest, Well ........................................Foundation .................... Prop. Line ..........-.......... REPAIR/ADDITION(Prev. Sanitation Permit# .._•......:.............................. Date ................... ............ } Septic Tank (Specify Requirements) ............................................ ................................................................................................. ; Disposal Field (Specify Requirements) .....---•...............•........:.....--._........---............._.............................................._............. . -•........................•----.........-----------------...--•------.....•...._..------..._._..........:.--------................................................._................__............... (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be dente In accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin: Local Health District. Home owner or lion- sed agents signature certifies the following- "I certify theat 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." 5: nec! Owner By ._ d_1" U Title ....ro ................................ (If other than owner) FOR DEPARTMENT USE ONLY ' APPLICATION ACCEPTED BY .._._..... QATE ....��l. f3 BUILDING PERMIT ISSUED ._ _.. ., .. ... _ .. -1-1...0......... ADDITIONAL COMMENTS ........................... f .. -• ------•... ......... ...... . .............. .... .............. .............................. .............. . , "/�' ..... ..._ Final Inspection b .Date P y. .............. '/ f- ..._-----•- EH 13 24 1-68 fiov. 5i SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M