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FOR—OFFICE USE: (�,OPLICATION POR SANITATION PgRh(, Permit No. 7'0... ....................... ......................... lComplete In Triplicatel. ....................... ................ Date Issued Is -7- ...... This PermIt Expires '! Year From Date Issued A .pplication is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work herein 549 and ting and Regulations:described. This application is made In compliance with County OrdinanceNo, axis Rules 0 - I la CEMS TRACT ....... JOB ADDRESSA ........................... ....... ......... ... ... ............Phone .......................... Owner's Name .,-------- .. ..... 0 i .... ......... .. Address .............. . ... .... ........ oty ............... .... .. .. .... ......License Phone,-'. ... Contractor's Name .......... Installation w.Ill serve- Residence 0 Apartment House Cornmelcial Effroller Court [3 Mat el El Other.... 7214. . .... Number of living units:_.....1.--- Number of bedrooms —2:7�—Garbage"Grinder ...... I&Size ...... . Water Supply: Public System and name .............. ...................—....... ........ .......................... ............Private Character of soil to;3-depth of 3 feet: Sand t] - Siff E3 - Cloy M Peat[J. Sandy Loom Coy Loom [3 Hardpan 0 Adobe[3 Fill M6terial ............If yes,type............... ............ Ole plan, showing size of lot, location of system In relation to wells, buildings, etc. must be placed on reverse side.) It see 0-pit P61mitted if bublic lower is available within 200 feet,) NEW INSTALLATION: (No septic ton or a Si ...... ................. Liquid Depth ... PACKAGE TREATMENT SEPT .. .Material. ....... SEPTIC TANK I;r. Capacity .1240A.14. Ty .. ---- No. Compartment$ em .................. , o . ..Foundation .....,1.J7 Prop. Lim .. . .. Distance to nearest: w . Jr 4 . Length --9 LEACHING LINE No. of Lines Length of each line------ Total ..... V Box .... Type fil'te'r Mdterial -Filter Material ....1f........................... Distance to nearest. Well ......a�f Foundation ... Property Line 11 Number -............. ............ Rock Filled Yes ❑ No SEEPAGE PIT [ I Depth ................. blameter ...... ........ ...........Rock Size ................................. Water Table Depth ........................... Distance to nearest;:Well ................ -------...............Foundation..................... Prop. Line ...................... ., REPAIR/ADDITION 1Prev- Sanitation Permit f .......... ........ ............... Date ....._...................._....__.1 Septic Tank {Specify Requirements) ..................................................................................... Disposal Field !Specify Requirements) -------..............11...... ..............••--------........--•---....._.._..._.... .......... ................ ------------------•-------•------•--•-......... .......... ....................1..................................................... ------------------------------------------- ................................ ...................... ..................I........................................... ....................................................--............. (Draw existing and required addition an reverse sidel I hereby ieftify that I have prepared this application and that the work will be done In accordance whir San Joaqulm County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health,01stAct.HOM'S awnw Or U.ton- sed agents signature certifies the following: permit is issued, I shall not *mPlOV any 11MOR in such manner 111 certify that In the performance of the work for-which this as-in become subject to Workman's Compensation laws of California." Owner Signed .... ----------------- By ...................L.. ............. .............L ....... Title lif other than owner] FOR DEPARTMENT USE ONLY ------ DATE -14 ------- APPLICATiON A�CEPTED BY ........................... ............. ..........................................DATE .I.....- BVILDING PERMIT ISSUED .... •........;--------- -- -------------- ..... ADDITIONAL COMMENTS - .. .............................I.-...-......-..-...- ......................--1........................................ ...... .. ....... .. ..........---................ ........................I........I............. . ..... ..........-.................................*.'..'.*."..*..................................... .. ... . . . .. .. �/ . .... ...................I..................... ......................... ................... ........... ......... ......................... Date /�/ Final Inspection 8/7h 3H EH 13 2h 1-68 Rev- SAN JOAQUIN LOCAL HEALTH DISTRICT