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4 ,. FOR OFFICE USE: — i APPLICATION FOR SANITATION PERMIT _... ..... Permit No. ... (Complete in Tripikatel Daft Issued This Pormlt Expires i Year From Dab hared � Application is hareby made to the San Joaquin local Health District for a permit to construct and instolf ttte work futetn described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regublissnsr ? JOB ADDRESS/LOCATI _.... .. ....... ...•- -... . /..... ..... .."CENSUS TRACT Owner's Name .....0c�.c.� yG�� L ..................................\� PF+a+e Address .:P.J 41 �r .... ......_........... City'..... ...:.. .. x, '{ �s-- Contractor s None. . `% _ /�e- L.......................... _....---...lksr..e li a?7.•l J.�� . PFtont y�...........,Uig' syr k Installation will serve: Residence 9'4partment House t] Commercial QTrailer Court r Motel Q Other................. ..... ................ b / Number of living u.'ts:. /------ Number of bedrooms ..f�.....Garbage Grinder iof Size „ .... �' ..� Chan rPo soil tblic System and name ................ ._......�.._____--------•----.....----•----•----..__..._.._.__.._.....—.. Prfvob �' Water Su I Pu `t Peat Sandy loom Clay Loans Q . '•�, xte o a depth of 3 feet: Sand D Sik❑ Clay ❑ ❑ Y Hardpan Q Adobe Q Fill Mcterlal............If yes,type............. r L ; xa ¢i (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc mud be plaosd an rwttrtte efd�.�. ' NEW INSTALLATION: - (No septic tank or seepage pit permitted if public sewer is available within 200 fed,) A 1 k; SEPTK TANK Size....................... Liquid Dspfh'r PACKAGE TREATMENT, (] I ] -- x T ... No. Comportments Capacity,.................... Type -•----.._....__.._.: Material..---•----... ..... Distance to nearest: Well ....................................Foundation ......................Prop.Line Length of eadt line... Total Leng'h -- � LEACHING LINE O No. of lines ......... . --•-....-• ' Yx' •D' Box ............ Type Filter Material -- Fouratf�pth Filter Materta�oy•` s Distance to nearest. Well ........................ SEEPAGE PIT [ J Depth .................... Diometer Number .............._ ine Rock Filled Yet ❑ No "� f` ._Rock Size Water Table Depth ......... -._ �> 0� Y .................... - + - Distance to nearest Well ... ..............Foundation Prop. Lute .... - REPAIR/A ioITION(Prev. Sanitation Permit# ............................................ Data .................... _..._.._.J r{` Septic Tank (Specify kequirements► ...:...... .......... a F x: Disposal Field (Specify R uirementsl ..`� ! s �. e�.... `/ L• / s til •.- G ........ ....... ....... ... .................................................._ - (Draw existing and required addition on reverse side) I hereby certify that 1 hove prepared this application and that the work will be done In accordance with See Ae�eir1 ~$ County Ordinances, State Laws, and Rules and Regulations of the San 1oaquin Loco) Health Dishid.Home ewne►or,IiOM•, ; y� f sed agents signature certifies the following: ors inds suIIIOIIt1M That in the performance of the work for which this permit is issued, 1 shall not employ any pert r I to a ub d to o► mart' Compeenaction laws of California." . Owner Signed .. Jitle .. .._. �. B ......... ' . .... ......... :......._ (if other than owner) g " .: FOR DEPARTMENT USE ONLY DAT .,.. 7 APPLICATION ACCEPTED BUILDINGPERMIT ISSUED ............................................................... . . .. DATE ADDITIONAL COMMENTS ln. �--, rt................................................ ...... ......................... .. . :`• •• f' .� .................................................... �.. ........................................... .. ... .... .. ................ ._ .... ..................................... .....Date �. .. . ............. Final Inspection by:G-•- - EH 13 21s 1-68 Rov. SAN JOAOUIN LOCAL HEALTH DISTRICT 8�l�, 3M 2. ;