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-A-', t� �,rrrrw;.x Wit: _ , APPLICATION FOR SANITATION PERMIT +.....,. ..-.,......' r � .................... IContpieh In Tripllcah) Permit No. ..7.6: ? Y ..... ...•............................ . ............ TMA Permit Expires 1 Maar From Date Issued Date Issued Application Is hereby made to the San Joaquin local Health District for a permit to .construct and Install the work heroin described. This application Is made In compliance with County Ordinance �No. 549 and existing Rules and Regulations: JOB ADDRESS/l. ON .� �- .:Y... �. ",t.�.....,..... . CENSUS TRACT Owner's Name (,��Q 3r' .`-��7.�. r............ Address ................W '= J -- �... :Phone........ Contractor's Nome . —... .. .......... .....................................Q�� City ..y�.�........... ttaense �. Phone ' f�.... Installation will serve, Residence Apartment House{] Commercial )]Trailer Court qMotel❑Other................•........................... Number of living units,..........._ Number of bedrooms ... .....Garbage Grinder ............ Lot Slee ..._�..<.-.?-��:��!. Water Supply, Public System and name .................. ...Private`s -._-..-• Clay 13 Peat)] Sandy loam ❑ Y ClayY /T Character of soll to a depth of 3 feet: Sand D Sllt o - Hardpan❑ Adobe Fill Material .......:....If yes type ...................7tr .. —� (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 permitted if public sewer Is available within 200 feet,) PACKAGE TREATMENT [ I SEPTIC TANK�Q cr ....................•--•--. Liquid Depth Capacity 12-0--0........ Type •- ..............Material-e-t-k.' ..... No. Compartments .._. .. . .. Foundation Distance to nearest: Well .._..f��?J............. F /�' Prop. 1 -�S ......••---•-•-•-..... o . L ne ..................... LEACHING LINE No. of Lines ............. _-_-- Length of each line-----. - .1......... Total Length�..��.( ......... // 'D' Box .....✓ . Type Filter Material, ...(�--�..::Depth Filter Material i Distance to nearest, Well ....`49P__.._____... Foundation ..../9 ' ..._.... property line .. Q. ------..... SEEPAGE PET ( Depth .--�� ...---.... Diameter _11.1.. Number ..........................�. Rock Filled Yes No Water Table Depth ........................... r � ... .._....._._.._....Rock Size • `Distance to nearest: Well ._....... ...................Foundation .... Prop. line ..7..............- REPAIR/ADDITION(Prev. Sanitation Permit jP .................... `Date ..._..........--_-•-• e, Septic Tank (Specify Requirements) ......................................... ...................................... Disposal Field (Specify Requirements) .........--•-•.......................------.......................................................................... ................................................ •------- ....................................._.._._.............._.....: ........ .:. (Draw existing and required addition or ireverse side) -1 hereby certify that I have prepared this application and that the work will be done In accordance with Son Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home ownay or licen- sed agents signature certifies the following: "I certify that In the performance of the work for which this permit Is issued, I shall not employ any person In such manner as to become subject to Workman's Compensation laws of California." Signed ............................ ....... .... ----------- ................ ..,........... Owner By --............. ......................._ If other an owner) FO DEPA TMENT USE ONLY APPLICATION ACCEPTED BY ......... DATE ,..:7. .1:'l.......:...:...... .................................. .. .......... BUILDING PERMIT ISSUED _...• DATE .......................... .......... . . ......................................... .............................. ...--•.-- AD ADDITIONAL COMMENTS ................................. ............................................................................... Final Inspection b ,M ...................... Y'C„�:."-5,��Ul- ......Date . �[ 13 24 1-613 Rev,-.- ev. SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M