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FOR OFFICE USE: APPLICATION SANITATION PERMIT �............. FOR SANPermit Na. ;7.. ...._._... r""" lCotreplete;lin TriplicaHl . ---.. This Permit Expires 1 Year From Doh lssued Date issued _- Application is hereby made to the San Joaquin Local Health District for a permit to construct and Install the work herein described. This application is made in compliant with County Ordinance No. 549 and existing Rules and Regulationsr e , JOB ADDRESS/LOCATION '4�/...... 1, • -- h?1l�....� CENSUS TRACT Owner's Name •-•-- - . .r�l..!e.C .._.-��,/ .....lr Phone - -......_ he __ Address ............. ---- ------....--- ---• (F-------------- ...City .. �? TG . y_.......Contractor's Name ,- -. , ? t Q, � � � License#ZZ.4� Ph — -- ....---•---•------ ------- --.. ane _..--•-----••- i Installation will serve: ResidenceXAportment House f] Commercial❑Trailer Court 0 Motel [j Other. g I, Number of living units:--J--_ Number of bedroom rba a Ender ..- tat Size ..,��.�.........................� � Water Supply: Public System and name ` - -----------Private ❑- - Character of soil to a depth of 3 feet: Sand 0 Silt 0 Clay ❑ Peat❑ Sandy Loom.❑ Clay Loam ❑ Hardpan ❑ Adobe 0 Fill Material ............1f yes,type (Plot plan, showing size of lot, location of system In relation to wells, buildings, etc, must be faced on reverse side P ) NEW INSTALLATION: (No septic tank or seepage pit ,permitted If public sewer Is available within 200 feet,l PACKAGE TREATMENT [ � ,SEPTIC TANK Size................... -.......... ....... Liquid Depth ......................... Capacity .................... Type .................... Material..---••--•------•----- No. Compartments P eats ----•............... Distance to nearest: Well .._-_-._._ ---..._..--Foundation Prop. Line LEACHING LINE [ ] No. of Lines ........................ Length of each line.............. Tata! Lth •••..................•-••- 9 D' Box ..-......... Type Filter Material __.-.......--- en_....Depth Filter Material -•..................................•--•--- Distance to nearest: Well ........................ Foundation .............. Property Line + SEEPAGE PIT [ # Depth --------__ Diameter ------------- Number ..........•-•--•........•--.. Rack Filled Yes .❑ No Water Table Depth ........................ .....Rock Size Distance to nearest: Well ............... Foundation .... Prop. Line REPAIR/ADDITION(Prey. Sanitation. Permit __.... Date •------•--•------ --•-•-. ................. i 1 ' Septic Tank (Specify Requirements) .-........- 'a Disposal Field (Specify Requirements) ...... _ .._ (Draw existing and required addition .-on---•rev- e•• r-s••---sid---•e-•) ...--••••... -. .................-..................... ... e 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 Rules and Regulations of the San Joaquin Local Health:District. Horne owner or Ilcen- sed agents signature certifies the following: "I certify that In the performance of the work for which this permit is issued, II shall not employ any person in such manner as to bec�o��j�jubj�arkman•s Com ensation laws of California.,, Signed -- C ► + L"Com'►s'.w K 111 ----• .....-. . Owner By -•-------•----------- --------------.. - Title ...- ... (If other than owner) -- R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - - -- ----- --------•------........ -----•------••-- -- -----•----- • ------- DATE - _ 757 BUILDING PERMIT ISSUED - _-}_ - - - -- - - - --•---•------------------------------- .................. .---------DATE ........................ ADDITIONAL COMMENTS -- . ..--... 40"in I Insp on ----- 41 ----------------------------------------------------- 13 2h 1-68 JQAQLtN LOQ HEALTH DISTRICT Dately �.,�... . g/7h 3A'I