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FOR-OFFICE USE: APPLICATION FOR SANITATION PERMfi j ......................................................... Pernik No.?8:..9�� (Complete in Triplicate) ........................................................ s Date issued -fmd---7,0' .10 .................... ......I.................... This Permit Expires I Year from Date laced 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 pm�ade in compliance with County ordinance No. 549 and existing Rules and Regulations: ...C �...�........................................... ! ' �•5 i� CICOJcpkO.%.l..y.........CENSUS E,NSUSJOB ADDRESS/OCATION - o .._----•..... ........................................ ............... TRACT .-................_....:._.`_/..._...... Phone . � Owner's Nam .. -ChAS............G .........................................: .............. � ........ Sm .................... Cit � n. ......... . ............ Address ..................... . � 88 -65 Contractor's Nam ......C• se ........................................................._ . {l Installation will serve•. Residence 0 Apartment House 0 Commercial]]Trailer Court O { Motel Q Other...LVAS N R W of i'3CeC5 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 Z Silt❑ Clay ❑ peat 0 Sandy Loom 0 Clay Loam❑ Hardpan p Adobe 0 Fill Material ............If yes,type................ ...... -- �ry (Plot plan, showing size of lot; location of system In relation to wells, buildings, etc. must be placed on reverse side.] 'J3 NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,] W PACKAGE TREATMENT [ ] SEPTIC TANK] ] Size--- �..-4-.61--••.-••-. Liquid Depth .....y» .1 t.... v 1100 CA CPM�wT PRecKtb1 .. V Capacity _._ ..... type Material.. ...__........... No. Compartments ........._ �- Cr 1 L Distance to nearest: Well -19.9.4 ..-LO 4.............._._...Foundation...Z9i ..»..... Prop. LEACHINGLiNE1 [ ] No. of Lines .......1.......--... Length of each line.......29.1........ ... Total Length ..._..70......-.-... • 'D' Box .Ar..... Type Filter Material .. 4; ,. Depth Filter Material -----1 c.1...... ...................... Distance.to nearest: Well ..Ipj5 ...9................ Foundation o.,.............. Property Line ... ...... SEEPAGE PIT [ [ Depth .................... Diameter ................ Number ............................ Rock filled Yes [I No C3 Water Table Depth -•.......................................................Rock Site ....................... ........ r Vo Distance to nearest: Well ........................................foundation ......._........... Prop. Line .......__----------- REPAIR/ADDITION(Prov:Sonitatiotn Permit'# ..... .............::.. ............ Date ------------------------------] rr Septic Tank (Specify;Requirements) .- ................................................................._.... ...._.._... ........_... ........_........._...... , r Disposal Field (Specify.Requirements) .---r-.:::...?..-.:_-........................_._............................................._ .-.......»...... .........................................................:....... .............................................»................................................................................._.... _..................... .- .. - ......----- -- _..................--.....---•.......:.- .................................... `- = —11)raw existing and iequiied addition on reverse'side) I hereby certify that I'have prepared this application and that the work will be done in accords"* with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health.Dlstrict. Home owner ar Ilcow sed agents signature certifies the following: - "I certify that in the performance of the work for which this permit is Issued, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ...........1..-------�--•---..... ... ........_.-._............................ Owner `T '.....1 .....1 (if other than owner R EPAR ENT U E ONLY APPLICATION ACCEPTED BY...- - - ..-.._ _...... ......................... DATE.:.._..9 ..S. ._7....._.......: BUILDING PERMIT ISSUED ...................... _.... .... - .....-----...............DATE ....__..--•-•-.......................... ADDITIONAL COMMENTS..... ... .. - ... Final Ins ction`b --- �SAN Dofe ...... ..� .- -t7•..---..•.•••..•• EH 13 24 1-66 Rev.'5t4AQUIN LOCAL HEALTH DISTRICT f/r74� 3M