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FOR OFFICE USE, JW ICATION4 ICOR SANITA-noN PEwff . (Complete in in Yrlpllcotal Permit No. 7 ............,_........................................ {. ': . diF Date Issued Thus Pemm4t Expires 1,Y' rem Date issued .............................................. _ a fix. - Application is hereby made-49 the San Joaquin Local'Health District for,a permit. to construct and install the work herein described. This application li-i mode In compliance with County.Ordinarice No. 549 and existing Rules and Regulotlonse JOB ADDRESS/LOC i0 .... ...Iza ........CENSUS TRACT ..... .................... Owner's Name � - -J . :.�t ...... � ` ......Phone .................. . City 1=7.6 ................................... ..�.^.. .. ..........3... Address .. ..... „ ..... Phone • cYfContractor's Name ...- L//ziell Installation ....__.�.. will serve, Residence❑Apartment House J3 Commercial f'Traller Court ❑ , _ Motel❑Other............................................ Number of living unitst......._.... Number of bedrooms ............Garbage Grinder ............ Lot Size ................... Water Supply=Public Systhm-and_�iamo .. ............ ....................................... .............................................._...Private�. Character of soil to a depth of 3 feet, 4 Sand o Silt❑ Clay ❑ Peatp Sandy Loamy Clay Loam❑ Hardpan❑ Adobe❑ fill Material ............If yes.type_.............. ............ = f (Plot plan, showi6g-size of lot, location of system In relation to wells, buildings, etc. must be placed on reverse side.) �— M +e NEW INSTALLATIONS (No septic"`fan,k or seepage pit permitted if��public sewer is available within 200 feet,l PACKAGE'TREATMENT [ ] SEPTICTANK� AZ--=- = Liquid Depth .......................... Capacity _ oeet. Type ' Material_. tY No! Compartments 64............... ' _Foundation : .' __...... Prop. Line . ._.. .........---� Dlstanc to heaWell •-• . LEACHING LINE [ Na. of Line” .f- .•.-�5. Length of ach line. ��..__....... Total Length. . ........---=•-. � �yD' Box .Tpe Filter Material . !..Depth Filter Material ...... .............................. — Distance to nearests Well ./ �d�s=oundation ............. Property tine -2 SEEPAGE PIT `[') `,:-'-'Depth ... ......... rDlameter :: ::........... Number,R - ......._........... Rack Filled Yes No Water .Table Depth-'P....._.........•--•..............•--••-.........stock Size ----..........:. .............. Distance twnearest: Well ......:........Foundation Prop. Line ..........--_-_----� REPAIR/ADDITION[Frau. Sanitation.Permit 4 � j •• .............. .......: Date .r�. r. .._. }_-...�"•.._.;b� , Septic Tank (Specify Requirements) ./ ........ e, � ,�1•fir ... 'E. ....., Dispo�I Field 15pedW Requirements) .............................. ..:..............:..-............................................................... `- ......................................................................._......................................_....,................_...._...: ._._.............._ (Draw existing and required addition on reverse side) 1 hereby certify that.*1 have prepared this application and that the work will be done In accordance with San Joaqul t County Ordinances,'State Laws, and Rules and Regulations of the San Joaquin Local Health District. Hone owner or lite sed agents signature certifies the following: 'I certify-that.in the performance of the work for which this per-M-11-Is Issued, I shall not employ any person In such manner as to beeomu subject to Workman's Compensation laws of California" 1� , Signed Y ...... .... Owner By . ... .f1.......-{.,. < ".. ..... ............. Title ....... _.............' ......._............................ - ;)lf other than caner) FOR DEP RTMENT USE ONLY I ' APPLICATION ACCEPTED BY ... ... DATE ............. .. . :. . BUILDING PERMIT ISSUED �. ..............................DATE ............... ADDITIONAL COMMENTS ------- - ----------- ----•- ......._........................................ ................ ..... __... ...... ...................... .........................:.................. _..... --------------------------------------........................ _ . - ......._ ... ... . ...... ......I....... .......------------- ----------......... r , °... .._ ... .......................:.................._... Oeste __..�Q. . '.�._. �..........._. Final Inspection by: . .... YEH 13 2a 1-68 Rev. 5 S N JOAQUIN LOCAL HEALTH DISTRICT 8/7]1 31"l