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FOR Or I'I:C.'E USE; I �t APPUCATiON FOR SANITATION t'BtI1AST ? ,Y .. ....... ...... ..... (Cermpieb In Triplicate) Permit No. ... .._. This permit Exlins I Year From Dab issued Dote Issued Application is hereby mode to the San Jocrauin Local Health District for a permit to construct and Install the work hento describeci. This application is made in compliance with County Ordinance No. 549 and exist;ng Rules mod RegulatkM* JOB ADDRESS/LOCATION2. y, ./... ............ ....... .............. .Ci?'NSLIS TRACT _ 7 Owner's Name :LL?...�.C�.C..L!.S1 ��1s.1..-_x.?C.'.�7�'Cl.............................._..............e'!!.w :7 ��`S�.. .S.Q.! Address ./ yC.C,....5. > c; P..� ..... ... �................_....._City ...2/-4 C'rL .. _.. -raContctor's Name �... Installation will serve: Residence 0 Apartment Hoye fl Commercial Mraller CAW Motel©Other..... ...C.. . ..0.f.. ...... Number of living unitse............ Number of bedrooms ............Garbage Grinder .. --------- lot Size ...................................»....._ Water Supply: Public System and name ..............................._._.............................--------------------------------».....Private i$ Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay C Peat CI Sandy Loam Q Clay loam {g Hardpan C] Adobe ❑ fill Material ............If yes,type.......................... (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed an reverse side.) NEW INSTALLATION: (No septic tank or seepage pit pompif public sewer is available within 200 fear,) NT PACKAGE TREATMESEPTIC TANK{ ] � '��.� ��/.G�........ . Liquid Depth .3/�......._. Capacity -oZ.y.CGn... Type No. Comparttnrnts ..3..........�. Dista. to nearest: Well ......,a�.C./.........--_---Founda ion ..../.Q..`....... Prop. Una...A �........».r LEACHING LINE [ J No. of Lines ..... Length of ends line.......... Total length O 'D' Box ............ Type Fher Material .............W.._Depth Filter Material .... Distance to nearest: Well ........................ Foundation ..... ----........ .- Property Una ............. t� SEEPAGE PIT [ ] Depth .................... Diameter ............... Numb@• ..... .......--.. Rock Filled Yes C) No C . Water Table Depth .................................._----------Rock Sl. ..........................-_... Distance to nearest: Well ..............................».-_Foundation ...... .. .......... Prop. Una »....... RVANVAII)M N(Prov. Sam! Iioo Permit#..._........................---........ Date ........... .....................) b Septic Tank (Specify Requirements) .......... .............................................................. --- ..».-----...----------- ----------- Disposal ---------Disposal Field (Specify Requirements) •-----------------------------»-- --••-- -------- .................................. -Fi.��`.. ........hack . ._......1C.. .��..c....._.... ?.c........roc!<.. ................_.........__. .._... ............... -•.................. ........................................ . (Draw existing and required addition an reverse side) 1 hereby certify that I haw Prepared " appiicotien and that the welt will be done in aooerdw co with Sen Joegrim County Ordinances, State taws, and Rales and Regaiatians t;f the San Joaquin Local health District.Home owner or Reos- sed events signatum certifies the feliewitnv: "I certify that In the poifm mrp of the week fair wlsids tisk permit is issued. I sW net employ any person to wtis manner as to become subject to Worker ern's Comsponsatien laws of Califormia." Signed ... - ..-. . ' Owner By .....�� /�..��/1 �'t�. .................-'............ .... Title .._ .. ........ J ill other than ownef� FOR DEPARTMENT ONLY APPLICATION ACCEPTED BY .�� DATE 1'�)-/7 73.. ....... BUILDING PERMIT ISSUED . .....- DATE ADDITIONAL COMMENTS Final Inspection by: �ti!'/ Date 40//C3/7`w SAN JOAQUIN LCICAL HEALTH DISTRt4 CT> f . 9 1-'613 Rev. SM i