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FOR OFFICIr USE: APPLICATION POR SANITATION PERMIT :.... ti................... {Coniplete.in TApElcate).� " .-�,.:.x: , : Permit No. ..75..-...93 +� - Date laausd �a- 6 f .. This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and Install the work herein described. This application is made in compliance wit County Ordinance No. 549 and existing Rules and Regulations: JOS ADDR1:SSlIOCATIO ._. S TRACT _ .... Owner's Name ` ' �` �''�`` T ' .. °`...±. �': _ Phone .c . Address ..................----j� f_...... ... .. .. ...-----......City ... _ ......... Contractor's Name . .....�._. � .t%�/ ---- -• License .. . _. Phone Installation will serve: Residence tKApartment House❑ Commercial oTraller Court 0 Motel Q Other_-_ti-=:_••-.......... Number f living units _..__ Number of bedrooms ° gGarbage Grinder _4.� Lot Size . .. 11 --•--•------------- Water Supply: Public Sstem 'name ....`-- _ ........ r v ❑....__ _. - Private ate Character of soilto a depth of 3 feet: Sand b Slit p Clay 0 Peat❑ Sandy Loam ❑ Cfay Loam ❑ Hardpan Q Adobe Fill waterial .......if yes,type (PlNEW plan, showing size of tot, location of system Imre,Eation to wells, buildings' tc must be placed on reverse side.) NEIM INSTALLATION. ( lo septic tank or seepage pit permitted if public sewer is availabEe within 200 feet,) PACKAGE TREATM#:NT did] '� SEPTIC TANK{ J Size.................. ... Liquid Depth C paditY-'---_--_- Type .................... Material------------- No. Compartments ...................... I Diston"c-e. o J^n arest--'Well` -------------- .....................F 6Uhd&io�"�`,. _" :--- Prop. Line ............:....----•. LEACHING LINE i J No. of Lines -_---------------_-. Length of each line.....Ar ...-----------•--...... Total Length ............................ , E T e Fitter Material .............Depth Filter Material Q $ 'D' ®ox . Yp k i Distance to nearest: Well ........................ Foundation ...... E... Property Line ........................ SEEP` AGE',PIT { Depth -----------------_ Diameter ......----------: Number .................. �-- Rock Filled Yes ❑ No 0 Water Table-Depth t Rock Size 1 A Distance to nearest: Well ...........................�=:...........Foundation Prop. Line REPAIR/�6DITiON Idev. Sanitation. Permit a# ! ---....--- --••---- Date--- . .... ..._. Septic Tank (Specify Requirements) ......_ ...... Disposal Field ISpeci€y Requirements)'"'" '`�" �: I . .. •-• F ---------------- ---- ------- -�--••---- cam`•--•-r -------------••-•--•--- [Draw existing and required addition on reverse sidel 1 hereby certify that I have prepared this application and that the work will be !done in accorditince with San Joaquin County Ordinances, State Laws, and Rules and Regulations of tho Son Joaquin �.ocaE Hsirith District: Hon4e owner or licen- sed agents signature certifies the following: 1 "I certify that in the performance of the work For'which this permit is issued; 1 shall not employ any person in such manner, as to become subiect to Workman's Compensation laws of Californla." { Signed . ----••-------------- --------------------------------------------------- Owner 1 Y -- - ------------- -------- •----- ......_.............-----......_•----- Tit e - ............................................ ` Ilf other than owner} FOR 00ARTMENT USE ONLY APPLICATION ACCEPTED BY .. DATE �� 7 - - -----------------------------------------------BUILDING PERMIT ISSUED ............•.............................................................._.......---DATE ........................ ADDITIONAL COMMENTS --------------• ..................... ------------------------------- ------ - - ---- --------------------------------•---•-- -----....---------- ------ Final Inspection by: --- ..............Date EH 13 2h i ce• SAN JoAQuIN LOCAL HEALTH DISTRICT 8/74 3m