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-' a AOR f SSE. APPLIQUft IOk SANITATION PERMIT *.... .. ........ u✓4... (cZapletein Triplicate) .Permit No. .. _ D 7 ........ This'Permit Expires 1 Yeo h*M Deft 1 steed Dote 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 ......L.� a.....s•... ..... ...........14.)Ay................................CENSW TRACT .......................... Owner's Name b.N!�. . ---�T J^m. ..c.�.ICA.............................................................Phone Addressf....WIV.......................I city 'y'a N ............................................. Contractor's Name ........................a.W-A_e_P............................................License# ......... .............. Phone ......................._..... Installation will serve: Residence 0 Apartment House 0 Commercial l_]Trotler Court 0 MotelQ Other............................................ Number of living units:....I------- Number of bedrooms .._,.---Garbage Grinder ............ Lot Size -7k._,X_..szZ. .7�.. ..1.h.��17 Water Supply: Public System and name .__...... ...................--------............._..._...........---•---_......................_._...Private Character of soil to a depth of 3 feet: Sand❑ Silt Q Clay [] Peat❑ Sandy Loam.0 Clay Loam Q Hardpan❑ Adobe 0 Fill Material............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,) pp PACKAGE TREATMENT I } SEPTIC TANK{ l Size................................................ Liquid Depth ....................,..... S go Capacity -------------------- Type -------------------- material...................... No. Compartments ...................... rDistance to nearest: Well ....................................Foundation ...................... Prop. Line...................... r LEACHING LINE [ j No. of Lines ------------------------ Length of each line............................ Total Length ....._..................... 'D' Box ............ Tyke filter Motorial ....................Depth Filter Material ........................................ V Distance to nearest; Well Foundation ........................ Property Line ........................ 7 SEEPAGE PIT [ j Depth -------------------- Diameter ................ Number ............................ Rock Filled Yes ❑ No C14 Water Table Depth ................................................Rock Size ................................ Distance to nearest. Well __._____•...................Foundation .__......_ ......... Prop. Lire ........._........... REPAIR/ADDITION IPrev. Sanitation Permit# ..............................................Date .................... Septic Tank (Specify Requirements) ...._—Aan A�:•� i.11%!.9 %�/01 ,�r i�1/ C -... / ___...t .� Disposal Field (Specify Requirements) __71.x.......0 ?,Ava.4....................................................•----•---................... --•--------•---------------------------- ..........-................................._......................................................................................................... .................. -------------------- ------------------------------••- (Drow existing and required addition on reverse side) I hereby certify that 1 have prepared this application and that the work will ba done In accordance with Son Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin fecal Hearth:District. Hence owner or Han- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit Is Issued, I shell not employ any person in such manner as to become b)ect t Workman's Compensation laws of California."�/ Signed. ..,�- _ �-/ al?/'„?Owner BY ----------------- --- ........................... Title ..... ............. ------ ...........-...--------------------•------- (if other than owner) FO EPARTMENT USE ONLY 01 APPLICATION ACCEPTED BY _..AIC-C--- .............. .......--................. DATE -A/—.7.. .y'--7. BUILDINGPERMIT ISSUED ......... ................................................................................................DATE .............................. ADDITIONAL COMMENTS ..... ....................... ................ ... .. r . : . ..................... ........ ........................................•- -------------- ----- . ...... ---------.... .............. .. ......_..... --- ••--------......._...._..Dater//-=/�-�7 -- . final Inspection by: -----.........................Cr.✓..._.. ..._._......_.._._...._.... ...._._.....,......_._._...._..----...:... .. .. . ... 13 2!t 1-68 Nov. 5M SAN JOAQUIN L HEALTH DISTRICT 8/7h 3M-