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. .. FOR OFFICE USE APPLICATION R SANITATION PERMIT .y Permit No. . .......................................... iCamplete in Trlplicate! ......................:........................I....__.. Date Issued .1..�".....'�� This Permit Expires 1 Year from Date Issued Application is hereby mode to the Son Joaquin Local Health District ford permit to conilruct and Install the work herein described. This application is made in compliance with_ County Ordinance No. 549 and'existing Rules Regulations: �� Q<. ldet2 .. ..........:.............................CENSUS TRACT ....... JOB ADDRESS/LOCATION ....�. .. -.. °__Phone 44�, `-.�`�r��.. Owner's Name ..._ /..--.rn�tJ7�/- �5.F1 -�,l .Z,r._•.. ........,City Q....................... i.... ......,...,................ . ......_......-..._ i Address ..- ....� 4 ... .. �-�� P.L?...... ...... .. 7° kT.�4/'{. , .Ss3. Phoned .W . x .. �9 R�l,S< 1.. a .�...... _....--..lioanse Contractor's Name .. Installation will serve: Residence( ''Apartment House fl Commercial OTraller Court C3 Morel pother ...........-.....a.......................... � eM�. � Number of living units:_--.-..... Number of bedrooms -sl......Garbage Grinder ._..... -. Lot Size � .... ..... . Public System and nam ............................................................ ...................................i.......Prlvate Q Water Supply: Pu y e • .... I Character of soil to a depth of 3 feet: Sand❑ Silt Q Clay to Peat Q Sandy Loam 0- Clay Loam-E] Hardpan Q Adobe 0 Fill Material ............If yes,type...................... (Plot plan, showing size of lot, location of system in relation to wells;' buildings, etc. must be placed on reverse slde.) NEW INSTALLATION: (No septic tank-or seepage pit .permitted if public sewer is avalloble within 200 feet,) Liquid Depth PACKAGE TREATMENT .( ] SEPTIC TAMC� r ............ she_��. ..:......................... Capacity I �. Type kA.�r01" e ••• Material&K !r?E=-••• No Compartments' ..: ::........ .. Foundation � .. Prop. Line ... Distance.to nearest: Well f ..:_. .........•••••;• � Total Len th? -.1.7Q ----•: .._ Length of each lin ,................. g LEACHING LINE No. of Lines 9 'D' Box ---1....... Type Filter Material .Rk.Depth .Filter Material .__ . :..-............................... i Distance to nearest: Well Foundation ....... �Q-.••••••••- --• ��®-----_...:.... Property Line 2, r �s `�__.. Number ..._..:.- ----- . ... Rock Filled Yes No (] SEEPAGE PIT Depth ...._ -._........ Diameter 1 - Water Table Depth _.. ................................... ..Rock Size ..l.f, .. ..SF��..`.. Line `` ;3: Founclot€on'-_-/��••••••• Pop. Distance to nearest: Well _.�.."SQ.Q_...__••_---......_.... ..... ............... Sanitation Permits ......-.f................. Date _............--=-•••----.....__..I REPAII;/ADDITION(Prev. _._......-------- E3 tl ' Septic Tank S eci Re uirements)- ......................................„_.........._:-•-. -__......_...•-•......--•.._..-••.-........_......Y.............. � p fY q -- � •- _ ................ Disposal Field (Specify Requiremintil ......................••-• ____'• _____________________________________ ..._ ........... ------------ ..........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-itt aaerdanu .with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San';Joaquln Racal Health,District. Monte owner or liven-. sed agents signature certifies the following: I "I certify that in.the performance of the work for which this permlt Is Issued, I shall'not employ any person in such manner as to be ome sub to Workman's C!777! ....ns 'on laws of California.” 12.4.5 ..° •----•AwnerrTitle Signed.-i�s-- 'n By ----- -•-•- (if other than owner) %3 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _.._ - ------ DATE i3UiLDING PERMIT ISSUED ................: =° --...--•--- .__.-DATE ....... ....................... --------- ADDITIONALCOMMENTS ---------- __---__---_------•------ ------------ .......--- .•--••-....-_.................._.._.:.._...._._...- fj -------------------------- o d` ...... Final Inspection by: . .!/d .." `.: • - .;._....... Date i EH 13 2h 1=66 5M SAN JOAQUIN LOCAs. HEALTH DISTRICT 8/7a 3M