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FOR C$FICI LASE: APPLICATI h .. ..: ...._ CAI. rOlt SANITATION PERMIT . . :.... ...:::..................:................... - (Complete In.Triplicate), Permit No— .... ... ....... . .. ......... ....... / This Permit Expires t Year from Date lssuw Date Application is hereby made to the San Joaquin Local Health District for a permit to constrL ct and in the work herein described. This application is made in compliance with County Ordinance No. 544 and existing Rules and Regulations: JOB ADDRESS/LOCATION. .. 1i�?. �./ i ;�7 5a4#/ oa. Owner's Name ................... .. .... ....Cf`NSUS TRACT ............... Address ......... /rJ� ...-_..... ...... Phone _...._..... - Cantractor's Name .. . Q ... city, ...:................................................ �� . ...... :.:.:fl _ . .-,..........Lkenae 27 n -•�=�---'Phone ��- Installation will serve: Residence)g-Apartment House Commercial C]Trailar Court -.. Motel[:)other Other ........................................ . Number of living units:_._..._ Nur►�ber.of bedrooms .�. .Garbage Grinder ^l_. Lot Size 4jGra4 '. . ` . Water Supply: Public System--and name ..._ .. ---- ...-- .. _ Character�of sots to a depth of 3 feet- Sand - .............. ..� .. ...._.r --� ................. ...........`----PrliratS0 -- [] Silt s Gay 0 Peat p Sandy Loom ] pay Loam ' Hardpan a Adobe 0 Fill Materlat ............if yes type............................ (Piot tan, showing size of lot, c ..., _ _._ S� Vtacation of system inrelation to wells, buildings, etc. must be placed on reverse side-1 f NEW INSTALLATION: (No septic*tank or seepage pit permitted If public sewer is available within 200 feet,! PACKAGE TREATMENT [ ] SEPTIC TANK '� Size..f,� .��.. .................... Liquid Depth r� .... ] . Capacity l . Type /' G��.. MaIerial.&.04c :!L,_: No. Compartments Distance #o nearest: Well ._ .`.........:.......... ►. -�P. . ......_6 .Foundation Prop.op. line LEACFIING LINE 5 -•----�----• No. of Lines .. Length of each line. '.`...::.... Total Length /,0&..............• 6 � s: 'D' Boxl-1f4? Type filter Material _. f p _ / �f. De Depth Filter Material t Distance to nearest. Wel! . .�.. -....-:_--. Property tine .�'�.., '~. Vk �S r Foundation ......... . T Depth i'. .......... Dic"neter �r V,/a.. Number' -...../-- ..........� 'Roeh FilledYes Na ❑ Water Table Depth _.... "l7.::.................r. .......Rot*Size . . ............ Distance to nearest: Well ` - .....Foundation _ ............. s.�:.Prop Line .e�.,�.f_......C` • R I'ePAIR/ADDITION(Prev. Sanitation Permit .. /f .,Septic Tank (Specify Requirements) ...... ..,__................... ..f Date ................... . ..... �....-• ...... ............r---•............. l .•...........v.... ...._............... w 'Disposal Field (Specify Req.uirementsl - f - .............. .............. .............................. ...........I........................ -•- - ! - ` (Draw existing and required addition on reverse side}. I hereby certify that I have prepared this application and that the work will be done in accordance with son Joaquin' Covety Ordinances, State Laws,--and Rules and Regulations of the San Joaquin Local Health,District. Nonce owner or 1146U. sed"gents signature certifies the fallowing: - "I certify that in the performance of the work for which this permit 4 Issued, I shalt not employ an person in such manner as .to become'sub(ect to Workman's Compensation laws of California." Signed ---••-. -_ ------ Owner BY ••---.._.._.., ._.. ----...---•--•--................_.. Jitle other t a awner# r ................... .............. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .._ �� - �}:.........................•-.............. ....................... . ............................ DATE ..:,... ..: SS—, J.............:: BUILDING PERMIT ISSUED ........ . ....... I___ ....::._DATE ...._._...- •- Ai7biTIONAL COMMENTS ................----------- ----------- I ..................... -----, -- Final Inspection - . 1 EH 13 2h 1-68 Yf t _ y N :_ ..� \1 �_� S N JOAQUIN LOCAL HEARTH DISTRICT 8/7h 3M