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PVK ..� FFIci: ease APPLICATION FOR SANITATION PERMIT (Complete in TriplIcate) Permit bio. :.,, This Permit Expires ! Year from Dote Issued .Date Issued . ..7` .7f_ 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 diva a No. 549 and existing Rules and Regulotionst Gl JOB ADDRESS/LOCATION)/ ... .._. .� C_EWU TRACT .......................... Owner's Name ..�SC ✓ .... .... .............. ....._.......__...............Phone .... ......................... Address ......... .. ---••• City ,,. .. Contractor's Namet.FE�'tc.�c.�- rLicense #62_0.Z/22' Phone - ... .. Installation will serve: ResidenceApartment House 0 Commercial oTraller Court 0 Motel 0 Other--- - ------------•---•••--••-------- ---- Number of living units:----Z-. Number of 71, oms .....Garbage Grinder _ Lot Size/�� ,�-?�'` Water Supply: Public System and name . ..... ...---•. •�_ -._ ---..Private ❑ Character of soil to a depth of 3 feet: Sand n Silt❑ Clay .0 Peat❑ Sandy Loam 0 Clay Loam" Hardpan 0 Adobe❑' 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. 1 NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet) PACKA+GE TREATMENT SEPTIC TANK]'" Size-�' f,2' r f 13 -",t S_.. Liquid Depth ._ . Capacity420__ .- .`.._. Type/ Material No. Compartments .�—r............... Distance to nearest: Well ..��_.---Foundation e.- ----- ,Prop. Line ..__ _______. - LEACHING LINE No. of Lines .__-A----__.___-__ Length of each lige.-.-___-__�.?4..___... Total Length :.17d...........-•_. D` Box Type Filter Material Depth filter Material �,rf,�� Distance to nearest: Well -tto .A1C ' --... Foundation .�f�............... Property Line �............... P% [ ] Depth _ ...... Diam ''x - Number _.....�................ hock Filled Yea No Water To le._T1epth --------. -- 7 .. .......-•-•••--•-Rock Size --.e�..P-�......-•-- r Distance to nearest: Well ----- -------Foundation ._. d--------- Prop. Llne -- ------------- REPAIR/ADb[TION(Prev. Sanitation Permit-,#...........------ ------------------------ Date .......................----------- j Septic Tank !Specify Requirements) -........ - -------- ---------•---..•.._..I..............-- ....------•.._..-._...-•-...... 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 done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin focal Health District. Name owner or licen- sed 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 mannan as to become subject to Workman's Compensation laws of California." Signed .... ----------------•---••-•---- ---•----•• ------•-•-••----------- Owner BYc... . `. --•- ----_---------__- Title ----... �.. ....... --.....-- (if other than owner) OR DEPARTMENT USE ONLY ' APPLICATION ACCEPTED B �.e�_._ � ..--- --- ................. ----- .. DATE ......� :-:_-.---------- BUILDINGPERMIT ISSUED -------------------------- -----DATE -... ..................... .............COMMENTS -- ..-------•--- ------ -•----•.................•------.-•-------------------•-------- ..................................__. .--=-------•------_------•---- ....-•-------__ ---------------------- -- ------- -•-- r ------- .......- . Ina Inspection by; .-_.. ...... - --- . ----- Date ._...Jr...-.. ----------- EH 13 2h 1.68 Rev* SAN JOAQUIN LOCA HEALTH DISTRICT $f7h 3M G5