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FOR OFF�CE USE: APPLICATION f01±< SANITATION PERM ��; �~ lCompletra In Triplicate) Permit.No. .:...........�r__.. :....._.......:....._............................. ,/� This Permit Expires I Year From Date lssUed Date Issued ...e. -k4l-'.._ Application is hereby made to the an Joaquin Local Health District for a permit to construct and Install the work herein described. This applicotion'is made in compliance with County Ordinance No. 549 and existint9ijuills and Regulations: JOB ADDRESS/L ATIO(N� .. __-- .�Q-•. rill . ---•__. ,(,TGA.._.............I............ CE14SUS TRACT ... Owner's Nam ! .1!.07 u4� .....................Phone'+ e-��.7 -........ Address ....... 0 ! � Contractor's Nome ..................License# ........................ Phone .4Z�.�c-.��.8 Installation will serve: Residence WApartment House❑ Commercial oTrailer Court ❑ Motel❑Other........ ............... �r8 , 0/7 Number of living units:-..R_-__--- Number of bedrooms •-__.---Garbage Grinder ........:... Lot Size ............... .... .... Water Supply:.Public System and name .._...._........._ ................PrivateCK Character of soil to a depth of 3 feet: Sand❑ Silt❑ Gay ❑ Peat❑ Sandy Loam 0 Clay Looms ,;,Hardpan Q Adobe X FIII Material ............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 permitter if public sewer 1s available within 200 feet,) PACKAGE TREATMENT f J SEPTIC TANK T' vaf •,,,- - -- �� .... _... Liquid Depth Capacity 0 Type Material No. Compartments ....&........... 1 Distance.to nearest: Well _. D.........................:.Foundation ....... .:�.... Prop. Line..... O LEACHING LINE No. of Lines __._�--.---.___. fine...-F0. 6 ` $�. Length of each .............. Total Length f��..........--Z D' Box .- .t .... Type Filter Material :: '.. . . . Depth Filter Material ....� r�.... ' Distance tofnearest: Well _e.49.l...... Foundation ........ � � Property Line � l SEEPAGE PIT Depth ...�i.�_�_._.. Diameter ._��r'._ Number _.........�i...... . . Rock Filled Yes�f Na ❑ � ' Water Table Depth ...Rock Size l ~ 311 1 �_ p e Distance to'nearest: Well .._....�� ................Foundation _._. D....r.. Prop, Line ......¢,•........ REPAIRJADDITION(Prev. Sonitation'Permit# ---.......................................•. Date .............................. Septic Tank (Specify Requirements)...........................•---........---•-------....................I ................ _ f. Disposal Field (Specify Requirements) .............. ` ..........................• ---•-----------........`].. .................................................................. ------------------------..._....._..--------------._............................................................. (Draw existing and required addition on reverse side)' I hereby certify that I have prepared this application and that the work will be do In,accordance with San Joaquin County Ordinances, State Laws, andRules and Regulations of the San Joaquin tocol Health,District. Herne owner or licen- sed agents signature certifies the following: "I certify that in the rformance of'the work for which this permit Is issued, 1 shall not-employ any person in such manner as to bec me sub)ect to Wori,Cma a'Co ensation aws of California." Signed By .......... .... ----------1� Title ... ..rr. ,::....................._._. (If other than owner) i "'" ' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.:_. DATE _. _:_ .___.: BUILDING PERMIT ISSUED . -'--• - ------- -----• •---- TE . ................••..._---.- ........:.DA ADDITIONAL COMMENTS ..au.¢. .......... .............I._..... •-•-•---- ------ ...... .... _.� ................................. i ......... _ ..------............--- ... Final inspection by: D- to ---.�--•--- - - ---•- --- ...... ate EH 13 24 1-613 Hev. 5MSAN JOAQUIN LOCAL HEALTH DISTRICT 8/71 3M