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-OR OFFICE USE: APPLICATION FOR SANITATION PE&.dT ". (Complete in Triplicate) Permit No. ._��.. -11. ._„•,_.,__._• This Permit Expires 1 Year From Date issued .: Date issued ..3.7/ ._7J Applicarion is hereby made to the San Joaquin local Health District for a permit to construct and install the work herein described. This aoplication is mode in compliance with County Ordinance No. $d9 and existing Rules and Regulations: OB ADDRESS/LOC�ION..�=':�•. CENSUS TRACT ...._. Owner's Name /i G'- ! /:.. _.:t'i.k.•.��: I�,.::r:__._... .. ........ _ .. -Phone Address `�' 7 City_ [ ti ontractar"s Nome .• _% � r . _-.-..Licari o afs�+r/' .�.1.• phone - nstallation will serve_ Resldenfe Q Apartment HouseQ Commercial QTrailw Court fl Motel r7 `ivmber of living units... ......... Number of bedrooms ............Garbage Grinder ............ IN Size .......:r,_."an L... .......... Water Supply: Public System and name ----------------------- ........--........................................Private 0— Character of soil to a depth of 3 feet: Sand Silt❑ Goy o Peat Q -'�ndy Loam Q Clay Loom ❑ Hardpan❑ Adobe Q Fill Material ------ If yes,type ..._•---------. ----------.. !Plor pion, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION! (No septic tank or seepage pit permitted if public sewer is available within 200 feet.► PACKAGE TREATMENT I ] SEPTIC TANK-[ ) Size.. �r� rY. Z...............-... Liquid Depth ._. '....-----.....- ,'� Capacity ------ Type. EJ%Material .:?`No. Comportments ._.. .....• Distance to nearest, Well -.,1� .-----------------••-•Foundation . ._�'_.......--_-- Pr Line op. - LEACHING LINE [ ) No. of lines . ...................... Length of each line............................ Total Length ........ ........... 'D' Box _... Type Filter Material ---Depth Fitter Material -----------••-•------------ Distance to nearest: Well . Foundation .._...................-_ Property Line .......___.---------- SEEPAGE PIT ( j Depth Diameter ................ Number .._ ---_---------- Rock Filled Yes ❑ NO C WaterTobie Dept ------------------------------------------------Rock Size ----------•-----------•----•- Distance to nearest: Wel! .foundation _ Prop. Line -------- REPAIg ADDITION Prev- Sanitation Permit Sit--- --------------..----------»----------- ate ...-... ._...__,_..»......___) Septic Tank (Specify Requirements) --------- ..... ------------ .. ____4..:..__.........._...--.----- 0lsposal Field (Specify Requirernents) --._....- - -. •---- --------------.,---------------— ..-....................-......................... ......... ---------------•--•-•-----.------------ (Draw existing and required addition on reverse sidell I hereby certify that I haw prepared this application and that " work will be cats! in sotordotrtce wilts Soo e44t or r County Ordinances, State Laws, and Rules and Regulations of the San laaguiw Lees! Model* Dishtd. Home owsser sed agents signeiturs,certifies the following: person in such ns4nns" ° I certify that in the performance of the work for which this Permit is issued, 1 thou sot estsploy awl► P as to became suhiect to warkmvn's Compensation laws of California.” •. ._ Owner Signs..��.y- �p � . .............. . jirle By 1�55 jif other than.dwned 10 FOR DEPART 810 USE ONLY C>iPTEO 8 ............ DATE 3 7 7 .S^ . APP!!CATION AC Y .1/ _.. ..... ....... ...__DATE _...-_ ...... ..... ......... BUILDING PERMIT ISSUED .. .` ..... .. ... ...........__......_.... �.- AOCITIONAL COMMENTS _ ........ .---•• .., .. ....... /.. _ ... .fir. .............. .......... � .Dare -.rr..f..._ /........................ Final inspection by: ..�' 1 I ..,/ _ SAN )QAOUIPL. t-COAL HEALTH DtSTRtC7