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>FOR OFFICE USE: ,` ' • ,.•... APPLICATION ICOR SANITATION PERMIT ............ "::....... .. :Q..... :.............: ' Permit No. x, (Complete In Triplicate) ;. 7s r.. ._....._..AIs .............. Date" sued This Permit Expires I Year From Date Issued .. _ Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION !`�o'��-•-- ,•-- �' Cl:tV5U5 TRACT Owner's Name`` ._�� ..�. .>1�-C � .................... yy.... Phone . _...- . Address ...-_....l-.Q-. - -. ..Ci L/.1 .... ...- - ---_-..... city .. -q I Contractor's Name ---- `-- _--•- :4:.-_ .. _. ..................License # ..z..�.�-.'/271 Phone Installation will serve: Residence(dApartment House Commercial OTraller Court 0 r Motel [:]Other............................................ Number of living units:_-___1_..__ Number of bedrooms __z2 ..._Garbpge Grinder Lot Size ��1.. ... .Q L ! Private Q. Water Supply: Public System and name / ....----•-----•----_................................•- .... Character of soil to a depth of 3 feat: Sand 0 Silt p Clay p Peat❑ Sandy Loam 13 Clay Loam ❑ Hardpan❑ Adobe 0 Fill Mater€al ............If yes,type............... ............ plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.} WW INSTALLATION: (No septic tank or seepage pit permitted If public sewer is available within 200 feet,) _- PACKAGE TREATMENT ( ] SEPTIC TANK I Size--- -.tel,pix. _�____________________ Liquid Depth ...SSS ...: '.:..-- Capacity pe .... Materiai,�i1� /. .SSN0. Compartments .-:--22 ............ 1 G.4-a.............._.Foundation p. Distance to nearest: Well --•- - - • - .....J,a..._......_ Pro Line ....15............. LEACHING LINE [ ] No. of Lines ........................ Length of each line-........................... Total Length ...................... `D' Box Type Filter Material Depth .Filter Material ... I Distance to nearest: Well ................:_...... Foundation ------------------------ Property Line....................... Il1 SEEPAGE PIT Depth . Diameter ..........:..... Number ............................ Rock Filled Yes 0 No C3 j Water Table Depth ..Rock Size ....................... Distance to nearest: Well ..foundation ..................... Pro Line REPAIR/ADDITION(Prev. Sanitation Permit# _W.......... Date ..................................} ' Septic Tank (Specify Requirements) ............. `1� ...... , . . .... �1 G� f, . Disposal Field (Specify Requirements) : -----a .. •---------------------------------------------- -----------------------------------------------•------------- ................•---.._------------------------------ ............................. (Drow existing and required addition on reverse side( t` I hereby certify that I have prepared this application and that the work will be done In accordance'with Sart Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health,District. Horne owner or'Ilcen- sed agents signature certifies the following: "I certify that in the performance 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 ..... .............. Title (If other than nerl FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -•---- -- -• 1• -•---•-- ---------------------...----....... . DATE—— � � -..-•-------- BUILDING PERMIT ISSUED ----------- - - _ � .DATE --------_--.----._-...... . . .._ ._.__. -------•-•--------------------------------- --------- ADDITIONAL COMMENTS --- ---- -- ---------- ..........:..... -•--- ---- ......_.I...........•-------------- -------------- - ------- --------------------------------------------- ...........................................................__.._....... ------- --•--- ------ --- - -- ..- Final Inspection by: .. . ....... ... ..... ......_...................... .................Date : ._._... ............... i14 13 24 1-68 liev• SAN JOAQUIN LOCAL HEALTH DISTRICT , 8/7h 3H