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FOR OFFICE USE: F APPLICATION FOR SANITA R " ` rt - ---•.............• ..._..._._..._ T�6N OUMJ" Permit No. (Con,pie4e in Triplicate) - •• •- ...... -- p , Date Issued/_-�,7,1? Thus perittit Ex' fret 1 Year!'rain Dari lftiied i Application is hereby anode to the-San Joaquin Lotdl Health ©isttia for a pet; if fb Construct and install the work herein described: This application is mode ;n compliance 1County Otdinante Worm wird existing Rules and Regulations., JOB ADDRESS/LOCATION . ._13...;... ;; ��-� '� f ��- ----- .----..CENSUS TRACT ........... Owner's Name Phone ........_... ' �• Address ..- iG�" City _ _ ...... Contractor"s - .✓''l.� -� �� •�::�- ��'��-'.'",.Phone �- Instollat;on will serve: Residence [ Apartinenf House CommercialTraiiei.Cour! f Mote`❑Other ...... ............ Number of living units:-.._. ._ Number of bedrooms ... .__..__Garbage Gtindet, .�..lot Size _ -�� /___-f� ." Water Supply: Public System and name .._ ` -- '��•r4�tx:�--�- - ---•-•----�.�✓ - ._. ..----•................---•----•- ---.Private. Character of soil to a depth of 3 feet: Sand Silt Cla' ❑ ❑ Y ❑ Peat Sandy Loam ❑ Clay Loam C] Hardpan C] Adobe Fill Mu Oteiial 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,) PACKAGE,TREATMENT [ SEPTIC TANK ....... ---- Liquid Depth N c .. Capacity -- .... .... Type --------_.........._ Material...- No. Compartments ---------_ - ........... W Distance to nearest: Well . ......_.__ foundation . Prop. Line ..- ----- ..._._...... - L ACHING LINE t�,}� No. of Lines ..f Length of each line ...... / t / _... .._ . ��-�----,....... Total length _.. ..Q;.--••---•--•---�J • . 'D' Box . Type Filter Material ... .Depthi --`•� - _.. _�..� Filter Material :... ... ......- .-.._..---..._..----••-• � 7•Distance'to-nearest:-Well Pro er line SEEP GErPI�s .... p tY ...---.. l[�} Depth f f7.....- Diameter f,/� Number -- hock Filled Yes rt- No C ' water..Table Depth / p Rock Size --------------------- Distance to nearest: Well .._ . _ . • ---------------------Foundation ..__. . . . � _ -Pro Line .._. REPAIR/ADDITION(Prev. Sanitation Oermit# --------- . ----- ------------------ Date _...'---- •. ----1 Septic Tank (Specify Requirements} :.._ ..- .. Disposal field )Specify Requirements) _...... 0✓1- t fi ' .... - • r ........................ k .._. t,s •.... ......:..........-_ ......_._.... _._.. "-_. ... --...-__.............-...... ................_...............------.._._... _....._._..... ..................-._._...._................. 1 ' (Draw�xisting-and-„require(Laddition_on_reverse side) I hereby certify that I have prepared this application and that the work will b•,deiw, in accordance with San Joaquin County Ordinances;”SFafe Laws,,ar_3:*Utes and Regulafions_af-the San-.loaqu'in fecal Wq ith D�Horne owner or licen- sed agents signature certifies the folio-wing: "I certify that in the performance of the work for which thls pperr`mit is issued, 1 dspll not .employ any parson in such manner as to become subject to Workman's Compensation laws of California." f I Signed ------- By t If ot- tie 'f" `�'t-'•�, t/ ic� r ; . .-_ Title !.............. ........... an owner} } �, „ ; lam• FOR DEPARTMENT USE ONLY f APPLICATION ACCEPTED BYE, c• i, - /�...... BUILDING PERMIT ISSUED ._.. `�_.�..?_•s. .. �• -' DATE, ..............."�4" _ � i..' '" DATE..... ....._ ADDITIONAL COMINENTS ............. ""------. . ; .............:................._ ... •-_.. . .............__.........._.."...... �- _ _._ _ - ....---:.--.-.--------- ----- -- -- --------. _... . .--------. - , l - Final Ins ect ---- . •-- -.-.-..........--- ...----...-- b --- Dat SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 13 24 1-'68 Rev. SM _ `__