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FOR OFFICE USE: ............ .................... .?PLICATION PCIR SANtTA1TION PEI. .T (Complete in Tripllpare) Permit No. .._... . ......._.................................... Date Issued .................... _....................................................... This Permit Expires 1 Yeqr Freer DWo Issued Application is hereby made to the Son Joaquin Local Health District for a: permit to construct and install the work herein described. This application is made in'c/omplionce with1CC unt/y Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ...(.//Q.C�!' 4,0 ........... ......CENSUS TRACT ...... .................. Owner's Name . ..........,�L,/.: ..�..._ aki C,�.......,..o.�............ ......... . Ph pe^1'................................... Address .................O .. ' .. .....9...F.......city .Z'f`}. ..�U..{.J..... ........................ .. . q rI �J� q �c -1 Connector's Name...... .s.. ... ...........:......::License•fP .pl.../.. r�.T� Phone '�tl..7sr-ot. Installation will some, Residence❑Apar ant House Q Commercial;eTrailer Court O Motel❑Other................. ......................... Number of living units............. Number of bedrooms ............Garbaagye-GAndgr ._......... Lot Stze ............................................ Water Supply, Public System and name ..............................:1-4.i-:CM.k4.........................................................Private ❑ Character of soil to a depth of 3 feet, $and n Silt❑ Clay ❑ Poor❑ Sandy Loam ❑ Clay Loam ❑ Hardpan❑ Adobe FBI Mgtwiol...:.:.......If yes,type............................ (Plot plan, showing size of lot, location of system In relation to wells; buildings, etc must be placed on reverse side.) NEW INSTALLATIONr IN* septic tank or seepage pit permitted if pu"c ?_gwer is available within 200 feet,) PACKAGE TREATMENT ( J SEPTIC TANK[ J yytt Slze.......�iA:.QaL✓.: ................... Liquid Depth .......�,ex3.:fds!r... Capacity 16.im...... Type P.J[.2. ... Mciwlal.. . .rn�. No. Compartments ...... ...�,............ �p O Distance to nearest, Well .............. .O.h.rc...:......Foundation ... 3/11%....... Prop. Lies s„J0Y-11, 0 LEACHING LINE [ J No. of Lines ...... LengtH'of each line........................... Total Length r •D' BOX ......... Type Filter Material ...........L.:.....Depth Filter Material ............................................ Distance to nearest, Well ........................ Foundation ........................ Property line ........................ Z SEEPAGE PIT [ J Depth .................... Diameter ..............;. Number .�.......................... Rock Filled Yes ❑ No ❑ Water Table Depth ...............................................Rpick Size................................. Distance to nearest: Well ........................................Foundation .................... Prop. Line ........._........_.� REPAIR/ADDITION(Prov. Sanitation Permit# ......................................:..;Dant ... ........"(� ....... Septic Tank (Specify Requirements) .a<47 T .'......j'�. iS _-•••.dam. . . ..... Disposal Field (Specify equirements) ...i.........�.(Gl ..��-' ,. - - ...rt �NN��A: +A':'.... _. )U Rts.2 ... ...r.....................................................:_..:. ......................................................................... .... .......... ...... ...................................................................................s........ (Draw existing and required addition an reverse side) 1 hereby certify that I have prepared this application and that )he work will be done in accordance with Son Joaquin County Ordinances, State Laws, and Rules and Regulations of 1Ko San Joaquin Local Health District. Home owner or Veen• sod agents signature certifies the following: . "1 certify that in the performance of the work for which this permit is issued, I %hall not employ any person in such manner as to become subject to Workmen's Compensation laws of itnlifornia." _ Signed .... .... ..... . ...... ....... . . Owner j� ByC� fi�G ..............................•7irle _.:... 0"4l-`t, (If other than nor) '''� FOR DEPARTAENT USE Q(•I,LY . APPLICATION ACCEPTED 8 .....,sr.�: .•.......:...::.............:......................,........_.................. DATE;,! .1.9 ;'Y................. BUILDING PERMIT ISSUED........... ......... ..........:......................... ...................DATE.......................................... ADDITIONAL COMMENTS Q !1_. �. d..t.... .11i .. cw...uwera.rs x,a,,... ....c. ............ d .... �� / 4 �� v .�...p�0?...r<is. "..S,TB .G.2:�r .,.a.a..._.r..r..:•-'-Nn'J�-m-- I :rr....,....k`.".">. ...�r....�o ,,: .. �..�..� .�...;r'..�:s......�...J cl/.�.... iFinel Inspectionb : ... . .�. ...... .. ,rr ............._.................:.�.......................Dafe7..��TJ......I...,........... .. SAN JOAQUIN LOCAL HEALTH QiSTJIIcT E. H.13 241-'68 Rev. 5M 7/72 3 N a