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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ..............._........................•----.......----- (Complete,in Triplicate) Permit No. Date Issued 2:-.............. :......................................—....... This Permit Expires ]'Vear From 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 lao-----------------/ +C IV CENSUS TRAC( � ..... .. .._ . / -------•................. ...................Phone Owner's Name � N/.ylP�__'_�.. ...�L/..S e... ...................:....... .. 91?r..7 . I Address ........... .......... ..................••--..=-__.._...-.City -......................... .......---................................. ..... Contractor's Name ---..._. R...IG'•f�..--...._... � � .,......_...License ..:..................... Phone �7 �� . Installation will serve: Residence Apartment House] Commercial QTraller Court 0 Motel ❑Other .............. Number of living units:---- Number of bedrooms ..7i_.'- _-Garbage Grinder ............ Lot Size .... .............. r Water Supply. Public System and name .Private i Character of soil too depth of 3 feet: Sand}] Silt o Clay ❑ Peat.Q Sandy loam Clay Loam ❑ ` 'Hardpan Q Adobe Q Fill Material ............ 1f yes,type (Plot pian, 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 s available within 200 feet,} PACKAGE TREATMENT SEPTIC TANK I - i s� �__ [ J � 3 �c.1'��N Size.... .. .................. Liquid Depth .......................... Capacity -:'---------------- Type COxC Material..;----,_ -- No. Compartments --- ....... -- {` R �l2 Distance to nearest: Well ---512.71.-1................Foundation ... Prop. Line _.�..">i...... LEACHING LINE [ J No. of Lines - /_________________ Length of each ..._._... Total Length ....7,da"- .......... 4 'D' Box Type Filter Materiel G•e'LCL._.--_.Depth .Filter Material ..... a It Distance to neatest: Well —510..-.70. ......... Foundation _._ .�t��'...,...._... Property Line ...s��..........r� Diartseter ---------------- fiber ....................... es ❑ "Nor'C C ,. . . .� I t i � .........Rock-Sue -------------..._...----•-•-•------•---••................•---•--•- it D' II ------------......................_....?fin L........... ........ � ....---. ............ REPAIR/ADDITION(Prev-Sanitation.'Permit#- .,A... •-----------------------------#Date -__--___. _......_..........} a Septic Tank (Specify Requirements) 1 Jof - •.....................-......_........_.....,..._•..--------.................. Disposal Field (Specify Requireinents) ,+Felt-.....:-.2.7.6Z ..�C.�..-A C?LlC, . ,, `J(Draw existing and iequired addition on reverse side) 1 hereby certify that 1 have prepared this.applicatlon'rand,that the work will be done in accordance with San .Joaquin County Ordinances, State Laws, andRules and'.Regulations7of the San .Joaquin Local Health,District. Nome owner or licen- sed agents signature Certifies the following: t • e "I certify that in the performance of-the work"for which this permit is Issued, 1 shall not employ any person insuch manner s as to become subject to Workman's Compensation laws of California." Signed ........................-------------------------•------------------------ -4 1.------- Owner By .........•---------------------------=------------------------•------•------•-• Title _....------. -- ...................... (if other than owner). 3 I. 01 OR PEPARTMENT USE ONLY.. . ,i APPLICATION ACCEPTED BY ..............._...--------------- -------...,DATE. .--..7-. .;��. .:rl--�._...,.:._.-: BUILDING PERMIT ISSUED ...-- -----.'._.-.-- ,. ` 4 -. D E 1.............. ADDITIONAL COMMENTS ...... 01 •- .....X #it-- * -�—•Final inspection by: -- .... �� i.;, '_------------ .....-- --- ------------Date ......... f Mi 13 .24 1•-613 J � � � 5M SAN fOAQUIN LOCAL HEALTH DISTRICT 8�7h 3M