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FOR OFFICE USE: 74PPiLICATION .,AOR SANITATION PF'' ,IT l -- ----------- (Complete in Triplicate) Permit No. ................ This Permit Expires 1 Year From Date Issued Date Issued } Application is4herebyd� J 1 al r t r permit to constru 'n I rk herein described. Thien/ls'4rrwa je N $49 and e i i R ahfi RegyJlations: , flJ� ' �rn�4 108 ADDRESSN4/o... c;1+=lir - 'a a.-.../t.. arl// , 3' d4_...._CENSUS TRACT ----- ------.. Owner's Name - n 'r----- ?'' ._, . -- ----- ----------------------------------------- ---------------•-------- --- ------ Phone --..._ Address ...... 1......- -------------------- City ----- ----------------••- Contractor's Name ..-- _.-�-xi) --------s-ti!-yr�l_1�----r�/V/.a�S-------License #a±Z'+ --- Phone Installation will serve: Residence (impartment Douse,❑ Commercial []Trailer Court Motel ❑Other -------- Number of living units:---: Number of bedrooms _.3------Garbage Grinder --!_IQ--- Lot Size ---------------- Water -._.__......Water Supply: Public System and name -.___---------------------- ---------- .----___Private Character of soil to a depth of 3 feet: Sand'Q� Silt El Clay ❑ Peat[I Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe.0 Fill Material -N.,p--- 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 INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 . feet,} � \ PACKAGE TREATMENT [ 3. SEPTrIC_ T�A�NKSize..� XS-743 _�__.--•------_._.-.- Liquid Depth ----4bi---/.....-- ca ocit No. Compartments 2 'Type� 31�F r> Material -,'� I t est: Well ----6-P_----------------------Foundation ------------ Prop. Line ------)----------- IN 4 ane. L ^ EACHING-CINE of Lines - +------- Length of each line 2j�� - - - Total Length �S-D------------- D' Box ...-� --- Type Filter Material44-�---.....Depth Filter Material -...._ g..__.•--•- •-- -------------•---- Distance.to nearest: Well ...J70............. Foundation ../0...._.....__-- Property Line ...St--.-------- SEEPAGE PIT [ ] Depth ..°___-- ,.._.__--- Diameter Number --- ---- Rock Filled Yes [] No 0 Water Table Depth ---- ----- ---------------•- -----Rock Size ------------- Distance to nearest: Well .............._--- ------Foundation ------------------.- Prop. Line ------..._..---...._. REPAIR/ADDITION(Prev. Sanitation Permit# ..............._----- Date .--------.._. } --- Septic Tank (Specify Requiremaht' }r':_'--------------.---------------------------------------------------------------- ------------------------------- Disposal Field (Specify;,Requirements) ................ i ----- - -------------- ---------- ----- (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to beco a subject to Workman' Compensation laws of California." Signed e -------------------------------------- Owner BY r " '` ftC_..._ h� 5---------- Title ... - � j [If other than ow r) --�-- I FOR DEPARTMENT US9 ONLY ,.,,APPLICATION ACCEPTED BY --.-----��'►-R-'_-------------- ----- t- r qq DATE ? �` �f--,..-- ---- ;BUILDING PERMIT ISSUED -- ----------------------- ------DATE ------- ADDITIONAL COMMENTS - -------- ---------------------------- ----------------------------- --------------------------------------- -- Final Insp. - -- -`----------- -- ---------- --Date . . - ---- ; SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M