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FOR O%FILE USE: ..................................... PLICATION FOR SANITATION PERMIT (Complete In Triplicate) Permit No. ................ . ........................................... .............. This Permit Expires I Year From Das*Issued Date Issued A..Zf-.6' ,f 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. S49 and existing Rules and Re tMotions: JOB ADDRESS/1vC.ATION ...307&ea....�,.....�.Q.N�T.RE�..... .....CENSUS Tf� ....`�:..........._... J Owner's Name . ......... .. v.8.f4.........�RL)CE./../.................. ..................... . ..... Phone. 117n..Q..7716... Address .....3Q.7.Q. .....11Z......LO-N.emel .........................City...A!9.K-PJ�-1=.................................». r - ? Contractor's Name.......0.W..N. .R................................ ..........._Ueense N ........................ Phone ................::. � ........... .......... ' Installation will serve: Residence ifA�pamnent House❑ Commercial ❑Troller Court ❑ .. Motel❑Other.......................................... Number of living units:...l...... Number of bedrooms .7�..Gorbage Grinder NO.. Lot Size ... .,....,... -S' Water Supply: Public System and name ................................._..... ..-..-'!X .................................. ........Private Cj Character of soil to a depth of 3 feet, Sand❑ Sift 0 ,*Clay 0 I Pe&❑ Sandy Loam ❑ Clay Loam 0--� d Hardpan Adobe ❑ Fill Material .. ........If yes,type , ... (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be plated o7st reirone side.) / NEW INSTALLATION: (No septic tank or seepage pit permitted If public sewer is available within 100 feet) i 1 r� PACKAGE TREATMENT ( J SEPTIC TANK( ] Size........... ............ ..... I..... .... liquid bepth, - ..................... .. Capacity .. ........ ...... Type .. . :....... 'Material ........... ........ No. Compartments .................... µ Distance to nearest: Well .: .. ........ .....Foundation ..... ..(_I Pra4p llrro ...._............... "\ .A LEACHING LINE O No. of Lines ............... .. . .... Length of each line........:. .. ...... .. Total'Length .....................Q'1, 'D' Box ..... ...... Type Filter Material ....................Depth Filter Mweridl ..........r.:............................... S Distance to nearest: Well ........................ Foundation ..................:c... Property Line ..:..................... SEEPAGE PIT ( ] Depth ...... ..__...... .........................b Rock Si:e'.,..................:.....Filled,, ill , Yes ❑ No O ,.. . Diameter Number ................. .............:...... Wat I p ...............................................Foundation .............Rock Pro. t. Distancetol nearest: Well ................. ........ . - . .. P. line .................... x' REPAIR/ADDITION(Prev. Sanitation Permit# ............ . ...... .. ....... Date ...................I Septic Tank (Specify Requirements) ........................................... .. ........ ........................... -............................... Disposal Field (Specify Requirements) ....AD.P......... YKIKL2-..........`..2J~ .Ph1.6rEL..,.PL7Y... ........4...... X.I.6 ./ v<:.......__SY'TEM..,............................................... ..... .... _._..__. .. ..._.. ........... ........... ..... . . .......-.............................. ........................................... (Draw existinq 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 ?'.r County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District.Home awner or licao- 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 manner as to become suble to Workmagf'3t Comp! sotto / ws of California." Signets �.�'LY /1'ti �^. (�'L,v ....... Owner By .._.. . _.. . . .. .. ..... . .._. . ..TKO.Title . . ..... . ..__...._. .. . .__ ......... (If other than owner) FOP DEPARTMENT USE ONLY APPLICATION ACCEPTED BY rI R. n' . ._ DATE .. /I..77.,-CL` BUILDING PERMIT ISSUED . . _ - - - ADDITIONAL COMMENTS "- -' - ---- ..DATE . . in 7-Inspec ion by._.. !.ylic�7. ../ IV1c{i(!� �� . Date ' �Z�4d SAN JOAQUIN LOCAL HEALTH DISTRICT E. K 9 1-'66 Rev. 5M