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r"" "r"`' vas APPLICATION FOR SANITATION PERMIT .............. Permit No p ) �6..-�.7 40 �'......................... Com letein Triplicate ...... ...............I............................. Thls Permit Expires f Year From Data Issued Date Issued�6:�T Application Is hereby made to the Son Joaquin Local Health District for a permit to constnrct and Install the work herein described. This application Is made In compliance with Count Ordinance No. 549 and existing Rules and Regulations: SOB ADDRESS/LOC ...........CENSUS TRACT .......................... Owner's Name .- • .!�.Z.. ........... . ........... Phone -----•----.. ....................... '`address ��.�...�, C".f. ............��.... i-.............. City ............................................ Contractor's Name " 1 -7. ------•............................Lloansa �It 154 _. Phone �.4�:�? '.`j.'C�... Installation will serve: Reslden&®'Apartment House Commercial OTraller Court 0 F Motel ❑Other Number of living units:..../._... Number of bedrooms ...._Garbage Grinder Lot Size ''�'� Water Supply: Public System and name ................................._---------____._------- ......................................Private� Character of soil to a depth of 3 feet: Sand-0 Silt❑ Clay 0 Peat❑ Sandy Loam 0 Clay Loom ❑ Hardpan(:1 Adobe fff Fill Material ............If yes,typo............... ............ !Plot plan, showing size of lot, location of system In relation to wells, buildings, etc. must be placed an reverse side.) h � NEW INSTALLATION: (No septic tank or seep,qgaFtit permitted if public sewer is available within 200 feet,) f PACKAGE TREATMENT [ ] SEPTIC TANK PJ Size...z/!r . _.�.................. Liquid Depth ....T .................. Capacity ------- Type ✓ - Material... . ?�........ No. r Compartments ...... .7' ........... J Distance to nearest: Well ..,.��.....................Foundation ............ Prop. tine ..,:5 ..;. .�... ..... . TEACHING LINE ' No. of Lines cr............. Length of each line._: r .... Total Length ...1.7 ...........�! • ... 'D' Boz _. ... Type Filter MaterialDepth Filter Material ......1. ..Y...........;V Distance to nearest: Well ............. Foundation ..� . ........... Proper y tine -�............... ........... . SEEPAGE PIT �Q Depth ...rJ �`� - Cr � ...... Diameter ��..-.......-Number.---•.......... ... ......._Rock Fllled�' Yes No Water Table Depth ... ...946............ ................Rock Size .'eRx �. =--' � f f Distance to nearest: Well _. _/A.- .....................Foundation .,.�l�.® ' Prop. tine ..J�.............. REPAIR/ADDITION dPrev. Sanitation Permit�# ............................................ Date ................................ .i E - SepticTank (Specify Requirements) ......................................... ...........................................:................... ..........._...............0• . tDisposal Field (Specify Requirements) .............................................................................................................I....................--� ..................................................................................................•----........... .................. ............................................ .......... (Draw existing and required addition on reverse sidei I hereby certify that I have prepared this application and that the work will he done In accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or Ilcen- zed agents signature certifies the following: "I certify that in the performance of the work for which this permit is Issued, I shall not employ any person In such manner : as to bee m subject to Wor ans ompensation laws of California. 5� gnedOwner - -- -° > . ---------------------•----•--..... Ow . title ......... .. .�........................... 11T other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ..... DATE ....��• ••..�`• •..... ••• '•' BUILDING PERMIT ISSUED ...... '... ..DATE.:.............. ............................................ ADDITIONAL COMMENTS ............ .............................. . . .. .......................... ..................................-....,.,.....--•-- ............................................I--.............--........ ...-- .................. . �. ...- ... --......_....- Final Inspection by: .._ .....Date 0:7. ...! .....' ................. EH 13 24 1-611 ilev. 5m SAN JOAQUIN LOCAL HEALTH DISTRICT. 8/7ii 31'4