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FOR OFFICE USE: - .. L. - _ b _ f�APPLICATION ICOR SANITATION PERMIT ............. . ............... , 7 t (Complete in Triplicate) Permit No, ..__........................................ This Permit Explros t Year Froin Dah issued Date Issued .1: !q �.7 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 compliance with County Ordinance No. 549 and existing Rules and Regulations: 106 ADDRESS/LOCATION ...C�.T y.... --Q ............................:...CENSUS TRACT ... �l,�T .....:. G�/ 1L.yl Owner's Name - � �' '• _ ,......_ ,,r/Phone •��.j/27.......... Address ...Q.B--sr. t�/7A��`'` �..... City �!•P�117....... ' ... Contractor's Name . �_f�.�:[I.!�t� i •-..._ ..f.; `."._�--.....License* _..!�_7 L7.4.1 kone - tnstallation will serve: Residelrjce ViApartment HodikCj_Comnierilal_❑Trailer&urt ❑ Motel ❑ Other,t Number of living units:...!_c_._ Number of bedrooms __.._ Garbage Grinder ._±�_-.._. Lot Size •........................ Water Supply: Public System and namew ------ --.._.................... .._...__...:..:_.......................... -private Character of soil to a depth of 3 feet: Sand D Silt ❑ Clay ❑ Peat ❑ Sandy Loam -0 .Clay Loam IJ '/HId.pan 0 Adobe o Fill Materlcl ...__._..:-. if es e I : yet, 1 (Plot plan, showing size of lot, locatlon!of system In relation to wells, bulldings, etc. must be placed on reverse side.j�, NEW INSTALLATION: IN* septic tank or seepagetp``it permitted If public sewerfs available within 200 -feet,)- f PACKAGE TREATMENT [ j SEPTIC TANK{ I SadSfrNi size ..................................... . ....... Liquid De Capacity . Q.Q..._.._.. Type - Material--��No. Compartments Distance. to nearest: We[ _Foundation .......... Prop. line LEACH( &E [ J No. of Lines ...................:.... Length of each line ..............._.._. . Total Length 'D'; 4 Sox1...__._. Type Filter .......... er Material ..........Depth Filter Material Y Distance to nearest: Well -. ... Foundation `' -�1 �:..;...................... Property !i' a............................ .. . SEEPAGE PIT [ J Depth ...................: Diameter .......... i..... Number ......._......:...........__ Rock Filled Yes ❑ No [j Water Table Depth ........................ Rock Slze ................. •- ... .......................... Distance to nearest: Well ................................... Foundation ....................... Prop. Line ................... REPAIR/ADDITION (Prov. Sanitation Permit # ............................................. Date ............................... t . Septic Tank (Specify Requirements)....................................................Q ..--- .�:.... / uirernents1 �----------- � p-._ Disosal Field (Specify Re 4 -4_,. . . ••-•....----- .......... . . ------------ -------------- (Qraw existing and requir�alt no on r rse side) 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,Disbict. Home owner or licen- sed agemis signature certifies the following: "1 certify that in the performance of the work for which this permit Is issued, I shall not employ any person In such manner as to become subject to Workman's 'Campensation laws. of California." " -k -:) a C? =` " =- Signed............................... ........... By...................... .......................... (if other than owner) --•------------------------ Owner ....:.................................- Title MENT USE ONLY, 11 APPLICATION ACCEPTED BY ...... ..--------------- DATE ......... ._Z.! -.7---- ........ BUILDING PERMIT ISSUED...............�........... _. DATE ADDITiONAL COMMENTS ............... .................---.......... a ...................................................................................... .�--- ina Inspection b �--,C-/ - ----•-•--••• P Y' ..........................................................Date . .Z./- •7 ........ 13 2� 1-68 Ne SAN JOAQUIN LOCAL HEALTH DISTRICT 8/711 3M