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FOR OFFICE USE: ... .... APPLICATION k'i!t SANITATION PERMIT T ..... . '.1 ........... (Ce;mpwo In Triplicate) Permit No. 7L.4. c.y _._. .._............__....._.............._... —This Per.10IfExpires IYsarFrom Date Issued Date issued .6.'.ac'tiP._76 Applicalon is hereby made to the San Joaqu'm Local Health District for a permit to construct and Install the work heroin descrlbea.This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations JOB ADDRESy!LOCATI k �-e _CENSUS TRACT .._ _.......... Owner's Name ------- •. /- ✓ %L fr .'.. .t.�/ ,� __....... Phone . .. ... . -----------........ Address .. Contractor': Nam...... X7t6[�G!. _l.P_3 r, .._: ...._jivense# . �1�?c... Phone ......................._.._. Installation will sen« Rnldertc- WApertrrment Ham((Coettneraial oTrager Cent 0 MSte1[]Other ......... .. ........----------------.----- Number of living units- Number of bedrooms .. Garbage Grinder Lotljke Water Supply: PublkSjtirern ono nurnn ................ Character of soil to a depth of 3 feet: Sand o SiItj] Clay [3 peat ZIaay Leant 0 Hardpan O Adobe❑ Fill Malarial ............Nyea,type............... .......... . {Piot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse We) NEW INSTALLATIONS (No septic tank or seepage pit permitted if public sewer is a)iloble within 200 feet,) PACKAGE TREATMENT ( ] SEPTIC TANK ji)' Size.. _��j (!'� - ............... Liquid Depth X..................._.� Capacity J&' e;...... Type 4?4:x Mahrial_...f�t C 0+4o. Compartments ....... Distance to nearest: Well .✓F ...•Foundation -----110, _._ Prop. Line •..I`..Y ..._... LEACHING LINE ( No. of lines - ------------ lsnglFt of each line....! . .......... Tohd tengNt ..... ....... 'D' Box .... Type Filter Material ....S.1.........Depth Finer Material ..... J............__. Distance to nearest. Well _...... .,,' Foundation -..../C/...`.:...... P1�opar y Line ..:� ..... SEEPAGE PIT (I� Depth --4..!/. . Diameter ..._ {� - T� -..... Number Rodc Filled Yet ....'..l. d No p Water Table Depth -------. .....1!'A': Rock Size .� _'e'3.'....... , Distance to nearest: Well .--- �IE��C.l----------------Foundation .../ Prop. Lint .. .�.- REPAIR/ADDITION(Prov. Sanitation Permit#..........._............................. Date ........... Septic Tank (Specify Requirements) ................ Disposal Field (Specify RequiremerHsj ................................. . ................_ ... (Draw existing and required addition on reverse side) _ I hereby certify that I have prepared this application and that this work will be done in accordance with San Jeaquln County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: "1 certify that in the performance of the work for which this permit is Issued, 1 shall not employ any person in such meaner as b become subject M Workman's Compensation laws of California.,* Signed ...- .... _.................. . Owner By . o- er now ill....( ,°t1- Its::............• Title `/ Of other than owner) _ R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY . .........- DATE (//11-3.t,... .......................... BUILDING PERMIT ISSUED . -.--- . - .__. ......... - -- .- DATE - ._.._.. .-------- . . . .. .............. ...-- A TIONAL COMMENTS ........._ . . . . . .................. _.. _. .... .... ...._.... .-... . - .... ..............-----------. �.�.. ...__._...... ......... ............_ . . _ . - ..- - ...._.----- ... Final ins - pedion by: G _ .. . ... _.._ _. _ Dant -a� -Z3 f.. . ............. EH 13 2!r 1-68 iter. SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7.)t 3M