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Newlow FOR OFFICE-USE: APPLICATION FOR SANITATION FiM MIT € ............. . • Permit No. -.... .:............................................. iCemplefslnTriplimNl y G ;_- -•- •••-••••-••••-• Da This Permit Expires 1 Year From Dale issued te Application Is hereby made to the San Joaquin Local Health District for a permit to construct and Install the work heroin .described. This application Is made in compliance with County Ordinance No. S49 and existing Rules and R"viaHmsk JOB ADDRESSAOCATTIO14 ...24I? . N 73 ...S........ .......}R iPow...... RD...............aNsus TRACT ..�0{"fi� Owners Name NlcA... . NOOFTEN.DdO?RN .....................................:.Phone 'Address ....:-. 21-Jr..73........5...........tv........RI.P,O,N-.....RD_ci ......... ' Contractoi s Name .O.W_N.EPS...............................................................License Ai ...... ......-. Phone .. LH—'Mi�,-� Installation will serve• Residence eAAportment House[] Commercial QTraller Court ❑ x ' 3 1 Motel❑Other... ......... - .......... L , ,Number n; .fling umts......�.;1... Number of bedrooms .3......Garbage Grinder .0. Lot Size A.C. `-- t.{ : Water Supply Public System and name ............. ... -.--:.: ....:...Private .. Character of soil too depth of 3 feet. Sand llt Q Clay Q Peat Q Sandy Loam ❑ Clay Loam Hardpan 0 Adobe 0 Fill Material tJt..If s, � . (Plot plan, showing size of lot, location of system in relation to walls, buildings, etc. must be placed on.Feveni�skls�y +� �� E •.NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is evadable within 200 feetl a t PACKAGE TREATMENT ( ; SEPTIC TAN*Vrl-': Size................................. Liquid Depth ..._....""�. i g . Capacity .. _..... ........... Type ...........:.::...: Material-:-.-_ No Corrlpanmems: �r N> yam' Distance to nearest: Well ....FoundaRbn Prop Line V LEACHING LINF ( S No of Lines .. .. .... .. . Length of each line ~_: tioMl Length rt /A 'D Boz .-...-.-... Type Filter Material ....... .Depth Filter Material .. Tf f V' ,• Distance to nearest: Well ........................ Foundation ....:'.-:: -` Property Ll - ,.,.... SEEPAGE PIT [ ( Depth . ... ............. Diameter ................ Nuri be. ......_._-....: ...... Rock Filledr'Yss ❑, ' Water Table Depth . ........................... Rock Size ... ti, Distance to nearest: Well ..................... Foundation Prof Lina - ! REPAIR/ADDITION(Prev. Sanitation Permit#........ .................. -... Date ...-- 4a Septic Tank (Specify Requirements) .C'ONNE`CT..T+D-..-E-X.ISrLNG 7liNf4..�—LE140HF[6LD L��VITN • r . i 1r �'. Disposal Field (Specify Requirements) Q15T_--:...BOX........3......LEAGf....LLN£S ....717 -.J:-�Q. 4 ` ?Y..-.... w�D>=.... .._%.....voDF_.... ...... . ........_ _.. .... .. . .. . ............... .._............- .........._............................ ....... i (Draw existing and reouired addition on reverse side) _ >✓,K as ' I heraby certify that I have prepared this application and that the work will be done in accordance with San eagdin .Y •� County Ordinances, Stats Laws, and Rules and Regulations of the San Joaquin Local Health District Hems awner a Been- U sed agents signature certifies the following: - >"•�. "�+ N certify that in the performance of the work for which this permit is issued, I shelf not employ any Paris in suchJnanner as to betas subject Werkman9 Compen tion laws of California." ., d' Signed ....�/ _ ' v l/.'�.'Y/!1/....... .... Owner •� By... . .......... . . ... .. .. ... .i. . ... . ................-. ................ Title ._. .............. r otter than ow er �/ -• ^} �j' e . '4r >. FOR DEPARTMENT USE ONLYAPPLICATION � w.a,..- >t' ACCEPTED BY.�I M .BROWN. .. t R'C _.. .� _.` :-. DATE .. - .... BUILDING PERMIT ISSUED .. DATE . . . ^- ADDITIONAL COMMENTS .brSTEM W5TALLED At VA. -.:M /SS NCE OF• PERrvtrT � .LFNEES. .ANT' .. EVAt_ 6.E'Nr9'Tif - . pIS� wEt.<_..,6.655 77iArJ Sc M is.....4 PT�D. .QYrIV•VT. APPROVE Wli�Tf WNERS KNOWLESD.bC 4 d,)C rine.InsPed n bY: . n,wi/1..� _� 7rf;� . - ... _..-... Date . .'7•-.z.,,d7r SAN JCAGudv LOCAL HEALIH DISMICT - ''Lv E.H. 9 1=68 Rev. SM - - - sr