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FOR OFFICE USE. G ?n APPLICATION FOR SANITATION PERMIT x (Complete in Triplicate) Permit No, .71 ....... . ... ... This Permit Expires 1 Year From Dat*Issued Mata 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. 349 and existing Rules and Regulations. JOB ADDRESSAOCATit N ` )?.----�:� ............................. ......,,.......CENSUS TRACT .». . . Owner's Name y. �! , .p'-. �+J � x .......:.............. .....� Phane .. ,f ....,.. Address .....,...,1. _.51..._. t.?. `' ........t.' 7. ........................ . » .., city .. Contractor's Nome _,.,..... r... . ..:., '.. Q .................License e.� r1 .3 .. Phone .` .- �07.. Installation will serve: Residence 0 Apartment House Commercial OTrollekourt 0 Motel Q Other.............:1.................._...._,.<:. � .17.? J X Number of living units:.. ....._. Number of bedrooms .. Garbage Grinder Lot Size Water Supply: Public System,ond name ...............................................g._......-............ _V.I..........._ ... Private................... _ j3 ykV Character of soilil to a depth of 3 eeto Sona—i3 Silt[:] Clay ❑ Peat O Sdndy Loam r, Clay LoamA4 Hardpan j �Y*Arddobe [j Fill Material ........_.-.a yes,type....................... I. — 1s � (Plot plcn,..showing:.stiA cli-Jot,,,location_ofjsystem in relation to wens, buildings, etc, must be placed on t )NEW INSTALLATION: (No septic tank or 9dWP`Sde�cpit.permitted if public sewer is available within 200 feet) rr" �� y PACKAGE TREATMENT l SEPTIC TANK 1"h}� a... .. .._> _.................. .... Liquid Depth .. T............... Capacity . -----.... Material..C^. No. Compartments Distance to nearests• Well`_ •' - r oundation .1.... .. Prop. Line", '..................F ..�... eT. ..T....... LEACHING LINE No. of Lines ...... ,--�-__ . Length of e _ line.... i Total Length �. ---...._.....�.._ ._..... �+ �'"'�► D,Soni .....4 c .Typeiiter..Mt*riai . ...._. bptfe lit* material .......>✓.. .---. t Distance to nearest: Well ......5_0....r..... Foundation .. : .............. property Line �..�'�"'. ...... SEEPAGE PIT •- - I I4 Depth .......... ........ Diamet r 'S Number ... .... _... Rock Filled Yes [3 No (� Water Table Depth .................. ......._.._..Rock Size ..... ..>... Diifonce to nelrest: Well ........,_..�.................... .Foundation _. ......--.---. REt+AiR/A�N(Prev.� i tifiation Permit ............... `�` gyp. Lir�.�:...._._..----.,... _ ....... .. .. Date ............. .) Septic Tank (Specify Requirements) ...--.---_•---.._................ �_...» ..... � . Disposal Field (Specify Requirements) ................................................................ . ._. „«..._. ...... .........rr...s. .................. ..................................-........................................ ......._._ .................... •__............•.....r...»................w...y ''�,•I»r n. (Draw existing and required addition on reverse side). ,........... . ......... .... » i hereby certify that 1 have prepared this application and that the work will be den* in aarordance with Son Joaquin County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Lava! Health District.Hem* owner or llc*n- sod agents signature certifies the following. � , "I certify that tri the performance of the w*rk or which this permit is issued�!-$ban not employ gay person in sta m+anow as to became subject to Workman's Compensation laws of Caiifernlo." Signed ... ......... ........... Owner BY ..... .. � W `....-... ......... ....... . (If of than owner) ._...... ... .,.... ..s............................ tFQ4 DEPARTMENTS VSJE, ONLY ,�•el, APPLICATION ACCEPTED BY...... _..._ ._.... _. DATE ,./. ,f..... .....,. BUILOING PERMIT ISSUED ............................................................... ..... ................... . .................----••--............ ...._......_.......................DATE ........................................ Ar)DITIONAL COMMENTS ............ .. .................. _........-.-...................,......._... �..._...................... ,,...»»................................................... .e:. . ..........................................................--_..............__.......:,.....Y_..........._...._......_.._... Final inspection by: ,c . Date _SAN.JO*AQUIN LOCAL HEALTH DISTRICT _ E. H.13.241-'68 Rev. SAA