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"PLICATION FOR SANITATION PEIe� (Complete in Triplicate) Permit No. ............... ................._-.-... This Permit Expires 1 Year From Date Issued Date 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/LOCAATI . //. .... � Ala_� CENSUS TRA.C. T. .. �nn....... ... .....,. Phone Name tf Address �c� 3/ 9Q' 5, City . •yL- - , "Contractor's Name _497,67C...Se:GG!Yl�-: LyaXG .................. License # Phone�5 117vZ.4.lcl Installation will serve: Residence SAportment House Commercial []Trailer Court ) Motel ❑ Other ..__...._.. -............. Number of living units: ... Number of bedrooms - ..._Garbage Grinder . /2.0 Lot Size ..�Q R't Z6r...,. Nater Supply: Public System and name .................. ... ............................................Private ' Character of soil to a depth of 3 feet: Sando( Silt❑ Clay p Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ AdobeFill Material ............ If es, ❑ Y type ............... ............ --tPlot 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,) ACKAGE TREATMENTr r I [ ] SEPTIC TANK( ] Size...L fJ-...---.`--.................. Liquid Depth -....: 5................ Capacity .-1i O e.. Type CL .4.4Ci .. MaterialLC L64 No. N Compartments -d.� :............ Distance to nearest; Well ..._! 5- :2...................Foundation .�.J. ............ Prop. Line -f Q....... W +EACHING LINE [ ] No. of Lines . _.. ....-_.-.- length of each line ...... Total Length .l�C:�?.�........... . L „ 'D' Box .J._._. Type Filter Material ...�... ----.....Depth Filter Material ...../.i 7..... _ Distance to nearest: Well -./1~�! � Foundation J_ _.._.. ..�J.-..._....._. Property Line ._ ....... SEEPAGE PIT [ J Depth .-. .•.—...... Diameter -----------_-- Number ....— ..........--_.. Rack Filled Yes ❑ No Q Water Table Depth ............__-._.----------------_---Rock Size _........... ............ - 7� Distance to nearest: Well ......_................___..._........Foundation .... ... Prop. Line ............... REPAIR/ADDITION(Prev. Sanitation Permit# .....--.._.......----- _..... T --....._-..._ Date .....--------------------------) o- _ Septic Tank (Specify Requirements) -.......................---_.----...........--....-------...----...-----........-...._..._...---_.._.....---...........---. �o Disposal Field (Specify Requirements) ------............---------------......__.----..................................._......._..._....................._....... w......-. __......... .............. _.._._.. .-___._..----........_.. .. (Draw existing and required addition on reverse side) hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin `runty Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: "' certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner to become subject to Workman's Compensation laws of California." Signed ._ ) Owner - ..- 9 GC � LttL __. _ Title . .. - (If other than owner) - O DEPARTMENT USE ONLY PLICATION ACCEPTED BY DATE L ING PERMIT ISSUED . . __- ....... - ...-..DATE ADDITIONAL COMMENTS -- _ -_.... _.._....._............... __ ..-... ........ ........ .... __........_... __ _ ... .-_ _. ..._..... __......_..... - _ Final Inspection by .. �' Date '..�_. ..._.. �" 13 2U 1-68 Rev. 51.1 Sr.N JOAQUIN LOCAL HEALTH DISTRICT 8/7L 3M