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FOR OFFICE USE: A LICATION FOR SANITATION P)EPWn& Perm.. ----------------------------------------------------- (Complete in Triplicate) -------------------------------• Date Esso This Permit Expires ] Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the H described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Reguh E1�.�--- JOB ADDRESS/LOCATION ._._I -----1 -`/ -''•-- ---------------------------CENSUS TRACTI'll __. .^ . 4 �� rr Owner's Name -- _14 /_ - L? 4. '------.W1:.Nl� -•---------- ---------------- --Phone ------------------•----••-_-- Address __.__l-��©�.-_._.�_.____L-7-�-y__..�__________________________________ City -. _ _.:___....____.._____..___....----__.. Contractor's Name .E .__. Tr� �•N- License Phone installation will serve: Residence E] Apartment House❑,Corrtmercial�irailer Court '.E] /� 1E f-C _.. Ct'PrN5 t ON Motel ❑ Other 1 _pM) c-- -Garba _ Lot Size _.: C_47i ............. ' Number of living units------ Number of bedrooms ______ _.., ge Grinder -_______. - t -----Private, Water Supply: Public System and name ----------------------------------------------------------------•---•--------•--- Character of soil to a depth of 3 feet. Sand'❑ Silt❑ Clay ❑ Peat10'__ andy Loam;, Clay Loam El Hardpan ❑ Adobe.0 Fill Material if yes, type -------------•------•----- showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) �. (Plot plan, g NEW 11�,STALLATION: (No septic tank or seepage pit permitted,if public sewer is available within 200 feet,) I PACKAGE TREATMENT [ } SEPTIC TANK Size----�/IYJJ X--6------------ ---- Liquid Depth _..�------ .......... •- , Capacity I �- TYpe 1�ECA5T Material Z No. Compartments --------- -------• _Foundation __ V ------•---- Prop. Line ---. . ... Distance to nearest: Well ------ -- — 4 = c :.---.__-- Length of each line--- _ - -- -- g QC`s----------- LEACHING LINE No. of Lines __ 1a-_-__.__.__ Total Length __-__ .___. o �K 'D' Box _�- Type Filter Materialr-�----.. - -•-- Depth Filfierr Material __.__._ - Q---•---------�---- , .. __ ....-- Distance to nearest: Well --- --------- Foundation __/0---------------- Property Line , SEEPAGE PIT Depth ------- --------- ___ Diameter ----------------- Number ---------------------------- Rock Filled Yes ❑ No t - Water Table Depth -------------------------------------------------Rock Size ------ ----------------------- Distance to nearest: Well _._______ ---- ------...Foundation -------------------- Prop. Line -------_----------- = - ) Rl:PAIRJADD1TlON(Prev. Sanitation Permit# ..----,• ------------ Date .---•---•---- ---•----•---------- _ Septic Tank (Specify Requirements) / • X__:_ __-15 ----------- Disposal Field Field (Specify R quirements) H-, C 'C 1.. 5----------36.--- -- � -----'--------- ----•---- ---•--------•-----•-- "_ f3uacGp-.- coNcr t= --_ReADI -P_._ CN..e<l. S ' ---- --------- --------------------- ------------- =- -------------------------------------------------------------------------------------- -------------------------------------------------------- (Draw existing and required addition on reverse side) I hereby certify That 1 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 Local Health District. Home owner or licen- E sed agents signature certifies the following: arson in Such manner "I certify that in the performance of the work for which this permit is issued, I shall not employ any p as to become subject to Workman's Compensation laws of California." Signed �-----140TH.0 ---VL-=---• G0-0- --------------- Owner By - - - -------- ---4....... .Title ----------------- --- ----- -- -- Ilf other than owner) FOR DEPARTMENT USE ONLY DATE - /--•---- Y ---- `APPLICATION ACCEPTED B BUILDING PERMIT ISSUED ----------------------------------------------------------•-••------------------- ---------=--------------DATE ---- --------••-----------------••-------•- ADDITIONAL COMMENTS _._ ----------••--------------•------------------------------------------------- - r �- , _ j------ -------J- --•------------- i - ---------------------- ---- ------ ..Date .'Ti �FinaE Inspea SAN JOAQUIN LOCAL HEALTH DIST?,