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FOR OFFICEVSE.. s a�O j S LQ 41 •� APPLICATION FOR SANITATION PERMIT ............................................. (� tCompMle in Tripucahl Permit No. .. .............. ......................................................... This Permit Exptnar s I YeFrear date tsswd Date lssued�a:ZZ Application is hereby made to the San Joaquin local Health District for a permit to constrtid and install the work herein described. This application is made in compliance with County Ordinance No. 519 and existing Rules and RogulaHorm JOB ADDRESS/LOCATION ��...p.��,( � SZ--' � ... . ....._c..).. . . -e.�....._.�.�Q...............................� TRACT . .__._,_.............. Owner's Name -...� !.•�� Phone eC3� Address . c�,�.,��._•. ...... ......�"�.1�. .......pit,, SContractor's Name ._�-./L ` c�..._.. ---.Z�-.;1.: ......................................Lilosnse il�`.� G- .. Installation will serve: Residence Apartment House 0 Commercial QTrailer Court 0 Motel0 Orhor............................................ Number of living units:..... .... Number of bar bbs .1 .....Garbage GrtndoryF,S lot Size ...7 Q-.. ....•......... Water Supply: Public System and name v�..i�E.!..(1.`.c. ._...................._-__....._...........I.........._.. .....----...Private Q- Character of soil to a depth of 3 feet: Sand E] Silt Q Clay Rf Peat Q Sandy Loam Ckgr loam Hardpan C7 Adobe❑ All Motorial............If yes,type............... ............ �� wwww��wuww■ww��•��ww�rr�w�ww�w�w�w�wws (Plot plan, showing size of tot, location of system In rotation to wells, buildings, oft. must be placed an reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted If public sewer is available within 200 feat,} PACKAGE TREATMENT ( ] SEPTIC TANK{ l Sire..................... ............... .. . Liquid Depth ............ ..vJ Capacity Type ...:............. ................... No. ComparlmeMs ............... O Distance to nearest: Well ............................ ...Foundati ...................... Prop. Line.. . ............ .p LEACHING LINE No. of lines ........................ Length of litre............ . .. Total Length 0 'D' Box ...... Type Filter Materia( ....... ...........De Filter Material ......................................-.._.. Distance to nearest: Well ....................... Foundation .................._..... Property Line .......................V SEEPAGE PIT [ 1 Depth .................... Diameter .......... Number ........... ............... Rock Filled Yes ❑ No Q WaterTable Depth ........................ ............... Size .. ...................... 3 Distance to nearest: Well ............. ................... ....Foundation .................... Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ...... ...•..... ......... ........ ..... Det .................................. Septic Tank (Specify Requirements) ..... //. _.. ......................I...............--- •---..... Disposal Field (Specify Requirements) .__ . j/..-�'!..Z �..._- /....}1./.s�........................... -•--•-. - ........................................................R. _-•••.. 36. �E-._-- a�K P� . ......... .. (Draw existing and required addition on reverse tido) 1 hereby certify that 1 have prepared this application and that the work wM be done In accordance with San JeaeioM County Ordinances, State Laws, and Rules and Regulations of the San ieaquin Local HooW district. Hoene owner or lien• N sed agents signature certifies the following: "I certify that in the performance of the work for which this permit k issued, 1 shall not employ any person in such manner as to become subjec;0,01 ,War n's Compensation laws of California." Signed_.... _ _. - .................. Owner By .... . ................... Title ....... / .........................--.........I................. (If other than owner) _ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- -./..!-17.V!S ................. .. ....._ ..._._.._ DATE -.. .. ---7•-�� -• BUILDINGPERMIT ISSUED .. ..............•_................................................•-..................._.......DATE .......................................... ADDITIONAL COMMENTS -....... --- .................. ............. .........�(f Final Ins ••----. lktte .. 37..... 13 2!t 1-68 Rev. 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/70 3M