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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Y Permit No. 76:1l a_7 ------ (Complete in Triplicate) _-. _ .. - _.............._...,y . .... .......... ' ' t` Date issued This Permit Expires t Year from Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to constrt; .and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: .SOB ADDRESS/LOCAT /ION ,_c l�� g��=1{{-....{/V�... �i fl�l,Gt�' R....K.c ..Ar... .43. .........CENSUS TRACT ........ ........ F !_.__...t�-�. .._._174...._ Owner's Name .. .. .R...................................................:................Phone ...' V. . AddressVS4.9.9 ._..__............. ....... City .....-............-......: Contractor's Nam ..... ..........License ..... Phone ...--e------.C�:S..r.1..:'?.'L:'�_�_._.-•............. .....................• ......_..,......... Installation will serve: ResidenceX Apartment House Commercial 0 railer Cou t 0 - t Motel Q Other ............................................ } Number of living units:._./------ Number of bedrooms ...AT....Garbagef Grinder ............ Lot Size ................... Water Supply: Public System and name _65.".W.N. K---'- .-•-i -=> ... . ...........I...........................................Private Character of soil to a depth of 3 feet: Sand b Silt.[] Clay Q Peat❑ Sandy Loam Clay Loam❑ Hardpan❑ Adobe 0 _Fill Material lf yep,. (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse slde.! NEW INSTALLATION; t :permitted if public sewer is available within 200 feet,) septicseepage A� +bE, � � ��., .+j.,...: : PACKAGE TREATMENT ]o SEPTIC TANK J� a e Size_ _-<.v..._ ._lr._.-�.... ...-.�?... Llquld`Deptk .... f:.5 .. ........_. I. q�t,./ .a- No. Compartments . ':7-r.........:.- .�C Capacity l2do. .+1t-/ Typehuxlh�lS.sMa#erial._��,.,� v-ti Distance to nearest: Well s7-------------- ---- Prop. Line :..s ............... LEACHING LINE ( ] No. of Lines -----1--------------- Length of each line_.. ........... Total Length. ......149 E'.'........ . w f+ D' Box .'.: .-... Type Filter Material _F&jee G----Depth .Filter Material ....�..`� ................•••••••• Distance to nearest: Well .._A4_4.7'4--------- Foundation _....1_fid ........_. Property Line .. •....... {� f SEEPAGE PIT ( } Depth ....I P--i---.---- 1D ete�r�X._..�Number :---...,f................. Rock Filled Yes R No am - Water Table Depth E' Rock Size ... ..... Distance to nearest: Well .....'>O!-------------•.---------foundation ..tea.`:....... Prop, line ..._sem ....,....._. REPAIR/ADDITION lPrev. Sanitation Permit# --------.-- ---------------- Date _-_.---.�................ . Septic Tank (Specify Requirements}. ------------ Disposal ,Field .(Specify Requirements) ---------------------------------------,---•------...-------•----...-----------------------....-....................:................. _ --------------------__---- ---- . ------------------------ .......... ---------- -----•-----------f --•- -------------------------- ............-........-----. ------------- -........__...._....--=----......._._.............. ...... {Draw existing and required addition on reverse - I hereby certify that I have prepared this application and th of the work will be done in+aciordance with San Joaquin County Ordinances, State Laws, -and Mules and Regulations of the San Joaquin Local Health,District. Home owner Or Ilcen- r sect agents signature certifies the following: "1 certify that,in the.performance of the work for whish this permit is_issued, I shall not employ any person In such manner as to becom jecf to Work 's Compensation laws -of California." Signed - -.------ r s- `- ----------------- Owner _-- . ------- Title ........ --..._ ..A............... (If other than owner) i FOR;DEPARTMENT USE.ONLY DATE APPLICATIBUILDING�ERMIY�ISSUEDN ACEPTED GY::.: C ..............DATE ...-1 _W � ._�..1--2-......... ADDITIONAL COMMENTS ----------------- ------......--•..................................................... ...�._...._.. ••-- . -- ----------------------------------'--------�_ _. -- ` -{' ..............................:.�� . ..... .................. D ,_- � .. Final inspettion by: _------•----------: J -----.... ...... ............. ate _.....-- ..r Eli 13 24 1-613 Rev. 514 SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M