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FOR OFFICE USE: APPLICATION FOR SANITATION P .......................... ......... EMANNENo. �0 .1complote in Trip"co%) ermN ,...... �._-.._. ........ /\ This Permit Expires 1 Year from Dellis Issued Date Issued .-,T itl.2. Application is hereby made to the San Joaquin Local Health District for a permit to construct and Install the work heroin. described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulotionst . ,339:., .G JOB ADDRfSS/LOCATION -�!-..................... ........................................CENSUS TRACT .......................... Owner's Name 'TU. kn....../ ....._ . . ..................•----...............,•._.__.......................--•-....Phone A6r.716,3.1......... Address - ..-..Tt_.A4......i.4...�l..e•--•--....__..._......_......._.................City ..�fo....----•f.o.. .�!.-....---..........._._._._......_-......_._.._ Contractor's Name ._A_WXIt --,-•---� ---- ---•-----------•-----•................ ...............__....License# ........................ P ...................----_----- installation will serve: Residence Ig Apartment House C] Commercial OTrallor Court Motel Q Other............................................ Number of living units:..../...... Number of bec(rooms .,3...._Garbo.ge Grinder ............ Lot Size .9a�.:--2n ........... Water Supply: Public System and name .._. ?`C 1 c.........,-.................... ........ .........•............_...Private 0 Character of soil to a depth of 3 feet: Sand n Silt Q Clay Q Peat E3 Sandy loam 0 Clay Loam)a VA Hardpan 0 Adobe 0 Fill Material if yes,type............... ............ \(� (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEVA INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,! , PACKAGE TREATMENT f ] SEPTIC TANK Size. ".�. ''.. :... S .. liquid Depth ..'`.......... ... Capacity 4--12-q...... Type)2' ... Material..fY.nl- tNo. Compartments �........... Distance to nearest: Well .....f .....................Foundation ..1 .............. Prop. Line —Y!. LEACHING LINE A4 No. of Lines —Z----------------- Length of each line................... Total Length ............_... 'D' Box YS ... Type Filter Material 4e;- .?FDepth Filter Material ._J��.................•........._.......... Distance to nearest; Well ../.61'V............. Foundation ...1./.T................ Property Line .� �.._.. SEEPAGE PIT J Depth .—.2-S S.'.... Diornoter -3.3--. Number ........... '.............. Rock Filled Yes. No Q Water Table Depth J47 ' .... . ....................•----•--•---.......Rock size ./..,�_ . ..-........_......--- Distance to nearest: Well ..14-0............................Foundation -./..o........... Prop. line Zr............. REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date .................................. Septic Tank (Specify Requirements) ----•---•.............................................................................................---- .......--•--•---•.-.-.-__.... Disposal Field (Specify Requirements) ....................•.............-------•--•.....-•---.........•....__........-•--•-----•---•---------•---••.............._......... .. •------------ ------------------- ----------------- .............................. ...................-....................................................................... .............__...... (Draw existing and required addition on reverse side) I hereby certify that 1 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 NeaMk.District. Nome owner or Iia w sed agents signature certifies the following: "I certif hat in ffie performance of the work for which this permit is issued, i shelf not employ any person in such manner as to me s ect to ma ' Compensation laws of California." Signed/- '�- ... •--------------------------•-•-•---......-•--•.._.._ Owner By / ......... ------------ ................................... Title ......... .............. (if other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _ ! .................... .........I DATE - ,:3_':.f. _- .......... BUILDING PERMIT ISSUED ........................ . ........... ........................ DATE . --._......-•--.._....................... ADDITIONAL COMMENTS ------- - ........................ ------------- .......... .........................I...........--------- ............................................................_.--.... ----------------------------- - ----................ -----------•---. ............. .................................---......... .........---....................................... FinalInspection by: ... ---------._._ -------------------------------------------- --•---....---- ------------._......-------....Date ........_......... ........................ EH 13 211 1-68 ifev. 5m SAN JOAOUIN LOCAL HEALTH DISTRICT 8/7h 3M