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FOR OFFICE U55 I APPLICATION POR SANITATION PERMIT Permit No. ............ (Complete in Tdpllcato) •................................... ................ ; Date lssued ..7r � .... •I This Permit Expires 1 Year From Dah Issued Application is hereby made to the San Joaquin local Health District for a permit to construct and indtoll the work herein described. This, application is mode In compliance with County Ordinance No. 549 and existing Rules and Regulationss . f t>. �+ L-I}MM__ _ .R ............................CENSUS`TRA JOB ADDRESS/i.00AT��I%fN .L�_ . ....-�?.yy.��._��}}e.A IAN .... -........ Phone . ............. Owner's Name ..�!..t .:..- ..-. h AR-- -•- -- .5�........... .. .. .. ..... ...... f� M- ...............:.....city ._ ... Address . . �.7. 7 � ..... Contractor's Name . .1T•- P.P._..� .............License ........................ Phone ........._.. . +.nstallotion will serveh Residence Apartment Hous jU Commercial oTroller Court ❑ ' -- a.._ -❑ �..�.- - Mote! Other.---._:.....--- .....................:•,�, % Number of living units.-----1 Number of bedrooms Garbage Grande . Lot Size ✓�� --- Water Supply: Public System and name ...................... ............... ....................1� .......................----.........Private❑ I1 ttl ,._,. ..�;,• -�,�::�- � _ r. _H ...�. - � .*yCharacter of soil to a•depth-ofd feet: San� 0 � Silt]—Clay Peat nd e iLoom Loom pd'- �d _ ardpan ❑_ .._Adabe fl -Fill Maortal51- 1 1f _ - ...r . _ . Y ,tY ...... ................ (Plot plan, showing size of lot, location of system in relation to wells, building etc. moat be placed on reverse side.) NEW INSTALLATION: (No septic,tank oreseepa a pit permitted if public sewer is available within 200 feet,l r -- �- ... Liquid Depth PACKAGE TREAT_M-AjNT�( -"`SEPTIC TAt�IC S1ie.:�.A.�� " 3�• - ........f Capacity I-P ..... Type �M^aterial C0/1/ I leo: Compartments ...---... ......_ r rr- I Foundation I ... Prop. line __DIS nearest: Well ..., � ............ ........ [ k ................... - R c ILEACHING LINE I No. of Lines ---• -••••---•••-• Length of ea�h' llne..._'`.' .... ........ Total Length . .. .�®......... �� Type Filter Material Depth Filter Material .........................r..... `D` Box l t ... Fo ndatlan ..... ..--.• Distance to nearest: Well .��......... � ..... ... Property Line .... ..................� � SEEPAGE PIT Q ( Depth .-. . Diameter Number Rock Filled Yes © No ��5 ' Wa er Tattle De_t ................................................ `. ...... - .......Rock Size --•............. '1 ......... V! i - -- `r l� Well .,. 'g Foundation ... Prop. Line Distance to nearest: ...................._.......� ......----- ....,.-- REPAIR/ADDITION(Prev. Saeltatlon Permit .......................... .........•••.... Date ............. ...................I Septic Tank (Specify Requirerrte3 ••- ... ............. ....... ......................�.........._.._............._.. 4 .. . ` ................. Disposal Disposal Field (Specify Requirements ............... ...................... ;'-•--- F } 1 ......... , .. :.................... .. ............................. 11 �R __ I hereby cern that I have re pied this application and that the work will reverse sidel�-rte . -------------- --..._ Draw existin and re aired addi#lon rk will be done in accordance "virlth Son Joaquin County Ordinances, State Laws, Rules and Regulations of the San Jooquin Local Health District. Ha nil owner or Ilcen- sed agents signoture rtifies the following: "I certify tha the rformanc jt the w rk for whlch this permit is issued, 1 shall not employ any person In such manner as to becom object o o kma"i's o laws of California." ��gned Owner ►. (if-otherthan_ow,nerl FOR DEPARTMENT USE ONLY •.� .... DATE .......•�': .`. ..:. ..........:: APPLICATION ACCEPTED BY ....-�J--l �. ........................ ..................................... BUILDING PERMIT 15SiJE0 9 � ......DATE>.............................. .--.-..-... ............ ... ADDITIONAL COMMENTS --- .............. `j. Date /.... -:(.- . Final Inspec : ....... .. Bi 13 2L 1-68 Rev. 5M SAN JOAQUIN LOCAs. HEALTH DISTRICT 8/7h 3M - ! i