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FOR OFFICE USE: , P. 5G11 ........_... APIRUCATION R SANITATION PIERM14 (Complete in Triplicate) Permit No. __7Sl-.__. ____ ............................. This Permit Expires 1 Year from Date lssue Date Isaued ................... 067 — SYD-6.6 Application is hereby made to the San .Joaquin Local Health District for a permit ArelAW11 the work herein described. This application Is mode in compliance with County Ordinance No. 549 and existing Rules and Regulations: '9/yY E. �• �n JOB ADDRESS/LOCATIONjzb-R.Ovt.,fe ..Q.M- -1---..ga-S.t.Q•f....C3.&r eZ4a..CENSUS TRACT .......................... Owner's Name Be—Al -VL' -•S----•................................._...._._..,..... Address . .9�_0. City .................. . . ..................... ........................ ..............�. Contractor's Name _ l't 9r� 83-�'� �...j,�e..��e .J.L1----•_._Q. f.. L.L!!�l.---...License �' ........................ Phone ........................�. Installation will serve: Residence>�(Aportment House Commercial❑Trailer Court 0 Motel ❑Other ................ ........................... Number of living units:... Number of bedrooms 2_.....Garbage Grinder ............ Lot Size ............................................ Water Supply: Public System cWd name ....... •----•...........................................----.........---.....................................Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam Flardpan;� Adobe ❑ Fill Material ............ If yes,type ............... ............ (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 [ ] SEPTIC TANK Size---._....... 12,0.-Q.................. Liquid Depth ------------. � Copac€ty/�b°_..._.... Type��._ ..... No. Compartments . . Material._. ?^ ....... . ......... Distance to nearest: Wel! _�J� �.......................F �tion ....../fir--- Prop. Line ......`............. <' 64 LEACHING LINE [ ] No. of Lines -.&-....... ........ Length of each line-... .__.._...........__.. Total Length ��............_... V Box .......-- Type Filter Material ....................Depth Filter Material ............................................0 Distance to nearest: Well -16-0.............. Foundation .......A. . ........ Property Line ........................Q Q,� r SEEPAGE PIT ( } Depth .426.... -- Diameter ............. Number ....2.----..._........ Rock Filled Yes�k No Cl Water Table Depth ------------....-- ----------------•--........stock Size ---------... ................... Distance to nearest: Well45-0./.............................Foundation ..... Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# -.------------------------------------------ Date ...... ....................... SepticTank (Specify Requirements( ------.............--------------------------------------------------------................................. .............................. Disposal Field (Specify Requirements) ........... --------------------------------------------------- -----------------------------.......•---.............................--........................................................... (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Mules and Regulations of the San Joaquin Local Health.District. Home owner 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." Signe -----------------•-- Owner BY • - 5 ('" c. Title ........... ------------ ..... ......................•---- (If other than owner) FOR DEOARTMENT USE ONLY APPLICATION ACCEPTED BY ..... DATE /� __lam ...7j.-------_ ------•---- ------ - -----------------------•---------- _ BUILDING PERMIT ISSUED _.. DATE --- ADDITIONAL COMMENTS C��-?�' r * wotH++d S.j� ....... .............. -�r� --------- - _.... . ° �� --------------------------------------------- ............................•-•-------I--- Final inspection by: _._......, ---....--- Date ...�/. ..a*..l+ l 13 2� 1-68 1 �• SAN JOAQUIN LOCAs. HEALTH DISTRICT 8/7h 3M