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FOR OFFICE USE, — APPLICATION FOR SAWATION PERMIT lCompleteln Triplicate) . . .. .. . ._......................._.. ..• -_ Permit No. .. .............. .......................................... ` This Penult Expires I Year From Date Iseued Date Issued Application is hereby made to the San Joaquin Local Health District.for a permit to construct and Install the worts heroin described. This,application is made in compiidiice with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOC ON .- . \ A.� . ... TRAC"f Owner's No .. .. =��rf Address .... . one ....................... ,a .�. ...................... �'� Conti a er .�/u" --:�1.?.� � ..................... ....... city t. ...........---•---•----...---....._..._.._.._. odor's N m �� -> License tl�y,f/.'. ,� r.. Phone .� J ..............•-----....- . _ Installation will serve: Residence Ig Apartment House Commercial OTraller Cour<� 0 Motel.❑Other. t ` Number of living � ` units: _--.. Number of bedrooms ..y.....Gbrba a Grinder/' lot.Size . ........... Water Supply: Public System and name „! 1 Character of soil to a depth of 3 feet: Sand[] Silt❑ pay ❑ Peat❑ Sand loam CI _ -r Q� ay Loam Hardpan Q Adobe❑ -Fill Mcterlal...._.... ..li yes,type -- r � v• t (Plot pian, 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 ( ] SEPTICTANK - JJ ' pth Sizea...... xXyx.�� De Liquid l .. .... t 1Capacity r,?�f� P_:.... Type Materlal4;c1.%.'_.. No. Co mpartmentsa�----• t t Distance to nearest: 1/i/e11 ......� _ ...._......Foundation ..,e'er�.......__ Prop. Line /�eJ`.��_.... LEACHING LINE.'- •�No. of lines 'y .?. . ' ngth of each line.. P_.. a .....-- - • --•-• . . .----•--•--•--- Total Length �r°•,C�...-•--•--...... � .; / 9t D' �Bozv�t✓-0..,Type Filter Material/.r;.te��.Depth Filter Material ,1 6!-..___._.._-•.•-••-,•••-___�:___ �) Distance to nearest: Well _ � --.- Foundation Q /. --------••--. Property Llne ............. SEEPAGE PIT [ 1 Depth.. ..............t._.: Oiametec :”" '--Num`ber ......................... Rode Filled Yea ❑ No Q �- Water Table Depth ................ ................. Size Distance to nearest: Well .........................................Foundation REPAIR/ADDITION(Prev. Sanitation Permit# ........ ................ ..._......_.......-- �. � .._..............__.. i� •.................. Date ----...._...._......».»...:._»} . Septic Tank {S ecifY Requirements)' .................................................._. » ...........- ..............-................ Disposal Field (Specify. Requirements) ------- ............. ............. •---............................... ............... .... .... ...........-.c........----.........................---.............................._:---..................._...... 1 4 (Draw existing and required addition on reverse side)- "- --; I hereby certify that 1 have prepared this application and that the work will be done In accordance with San Joogvin' County Ordinances, State Laws, and Rules and Regalatioris of the San Joaquin Local Health,District. Home Owner or licew sed agents signature certifies the following- "I certify that in the performchce.of the work for which this permit is issued, I shall net employ any person in such manner as to become subject to Workman's Compensation laws of California.,, Signed --- ......... Owner BY q Title .... er than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -----••.................. .. _._.`'�/__ - ' BUILDING PERMIT ISSUED .................. . ---• -- •------..... .--...._.. DATE ----•-•--••----- .._. ............ : ... ..:.. .-DATE ...........•--........ .. _ ADDITIONAL COMMENTS .....- . • •- ' • -••••�•••••----- ............ ............... ........................ --•-- , f� ..................................... ................ ............. .. ....... �..- .;•-•. -- ...... .. . Fina l Inspect) G�..�_... '. EH 13 2L 1-6 E1, lieu. 5t�1 ..:. Date .. .... . -�3. ............ SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M f ' i