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•' evn v.irr��.7G ;.. �? p APPLICATION FOR SANITATION PERMIT � ....... (complete In-T011cate)_ Permit No. 7.7...:3.x. . .,, � Dates sued ..�:i•:3:.?� ......................................................... This Permit Expires 3 Year From Date Issued Application Is hereby made to the San Joaquin Local Health District for a permit to constrict and Install the work herein described. This application Is made�In,compliance with County Ordinance No. 544 and existing Rules and Regulations: JOB ADDRESS/L .�. /.....�..r.........� .l.�esrf L..!.................. CENSUS TRACT .......................... = * .. .. Owner's Name ...... �r. :G�ts -r..... ........... Phone .................................... Address ........., .r,�. ..........G --.... ��•-- .C......._..'City ............... ............... Contractor's NoM- a .d.r... t<Gfa ..�r1. .e..licenss 9�.0.,Z47..ZPhone Installation will serve: Residence Apartment House f3 Commercial❑Trailer Court ❑ Motel❑Other. s q Number of living units,.....f... Number ofrooms .....Garbage*,Grinder . . Lot Size . ..�,n. i.,: ........... Water Supply: Public System and name - b . : ... .... .f: . &.: .—................................................... f�rivats Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ day Loam ❑ Hardpan❑ Adobe Fill Material ............If yes,type (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc, must be placed an reverse side.) NEW INSTALLATIOW (No septic tanlc,or seepage pit permitted If.public sewer is available within 200 feet,( PACKAGE TREATMENT ( ] SEPTIC TANK kr Size......a.....Xf7.......... Liquid Depth ....Is.. ........... { Capacity ll(t7?TW,21. Type Ax c ee aterlol. A o. Compartments .: .. ...... . r . ... ... .r ......t Distance to nearest: We ,Foundation .. .s..... ..... Prop, Line l" LEACHING LINE , AY No. of Lines ...... ._Z.............. Length of each I ne.. .FS. r__ ... Total Length . . ...............S 'D' Box .... .. Type Filter Material .46 ...Depth Filter Materlal . .,1.' .: m 10 Diifance to nearest, Well 114.-*.t oundation ....,,1j'`....... Property Line ..:�.. ........... SEEPAGE PIT ( Depth q e— /.... Diameter --- .` Number ......... --------------- Rock Filled Yes It NoCIE Water Table Depth -------9`��90.. ...................... Size ...c ......� .... f Distance to nearest: Well .. ... L44.......Foundation .IQ.......... Prop. Line ... ..........••-..,� REPAIR/ADDITION(Prov. Sgnitatlon P(rmit# ......................................... Date .................................. V) Septic Tank )Speclfy Requirements) ......................................... .....-•---................................................................_................ DisposalField (Specify Requirements) ............................................................................................................._. ........................ .......................................................................................... -...................---••-......................................................................... ... . J . - jDrow existing gnd required addition on reverse side) ... . .. . . . . .. . 1 I hereby certify that I have prepared this application and that the work will be done In accordance with San Joaquin 3 County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home awn" or Been- red agents signature certifies the followin_g. .. "I certify that In the performance.of time work for which this permit IS Issued, I shall not employ any person In such manner as to become subject to Workman's Compensatlon-laws of California." C1ARr-!,!u4'S SE?i!C & S_EWER SERVICE Signed .../�/ J ..•---...:.Owner By ........ .--.. � --......... . ... .�. 2 i!'i SinCl;iGri, �F if. ��LQS lll�� Title �.:�. . ..C:�{[Y�ti{e-'s= i (If other than owner) FOR DOARTMIENY USE ONLY APPLICATION ACCEPTED BY....... . . .. ....... . . ............................................ DATE .- .................. BUILDINGPERMIT ISSUED .......... ............... ...................................-......: DATE ........................................... AI7[)IfiION COMMS ' ....... .....` ................................ •..`:.`...........................:.......c..., ....,....................................... ---.-- ................................. . .. .... ......... .. . ........................................... .................... .. ..................... .. Final Inspection by: ............................Date EH 13 24 1-68 SA JOAQUIN LOCAL HEALTH DISTRICT $/7}