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FOR OFFICE USE: , APPLICATION FORSANITATION PERMIT. ....................•..........- `I ? Permit Na. J ...................... . 1Complete in Triplicate) 7C � ..............................................�1�..... . This Permit Expires 1 Year From Datelss.ued . # Ili Application is hereby made to the San Joaquin Local Health District for a permit to construct and Install the work herein described. This applicatioA is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ..... ._Q .t �7. 1 rV,..,B.. LDTtirL � , .A..+..,..,,CENSUS TRACT ....... .............. _ r F Owner's Nar4e ..... .-� - .f}1 .R ----Phone . Address .�U, . ._. ....... City �.1.4�.D.:^' . Contractor's Name ....� �. _ -. _......:-- �a.1 T :(3_C ............:.Licenso # -- Phone Installation will serve: —Residenee.Q Apartment-House.0 Commercial[]Trailer Court 0 [ Motel ❑Other•- ..................... Number of living units L!... Number of bedrooms .....Garbage Grinder Lot Size jl��.X.�. ...............O • m , Water Supply. Public S stet; and name .._. t .---II�1C.. ...........` 1.t�i .........� .L �:T............Private ❑ s � . Character of snit to a depth of 3 feet: Sand[] Silt❑ Clay ❑ Peat.❑ Sandy.Loam 0.—Clay-.Loam-o[.»._,::.- � s Hardpan ❑ Adobe ❑ F111 Materlol .'.......... If.yes,type ............... ............ (Plot plan, showing sizeflbt, Iocation�-of=system-en relcation�to=wells; buildings, etc. must be placed on reverse side.] NEW INSTALLATION: .a ( 10 septic tank or seepage pit permitted if public se er is available within 204 feet,) PACKAGE TREATMENT [ ] .,'SEPTIC TAN1C Size........ �L � '-... Liquid Depth ..............•--•-•-••-•- CfP ty .................... Type ••--••-------------- MaterialNo. Compartments ..:.:� �_........._ Distance to nearest: Well -----...g..-�.....................Foundation A.0............ Prop. Line ...:.�............... LEACHING LINE Ntof: Lines --..-_2.............. Length of each line......... r �1... £ .. ............. Total Length J..��............. !/ yl '©:p Box .__.�.._... Type filter Material -&.(el.......Depth .Filter Material ..�.T. p t Distance to nearest: Well ........................ Foundation _.. ............. Property Linet ...U�.................. SEEPAGE PIT ;[ } Deth Diameter ..........:..... Number ..............'._..._...._.. Rock Filled Yes ❑ No (3Water Table-Depth - . - Rock Size r__�_ __ Distance to nearest: Well ----••------------------------------- -- REPAIR/ADDITION Founds#ion .................... Prop. Line ...................... �IM f ------ _-,.__..__`....(Prev. Sanitation Permit# ------------- --•----- �--- ,.� + - ------ ....................} --, Date Septic Tank{Specify Requirements] .................... Disposal Field (Specify :Requirements) _ ............... ----.. F ------••---•- F --- ----------------------------------------- ---- ---------- --••------------------------------------- � � l ..................................--------- - F (Draw existing and required addition on reverse side) s ! hereby certify that I:'have.prepared.Phis,-application,and-,-thaf„lho'-*ork"will be done in accordance w d Sa!quin County Ordinances, State laws, and Rules and Regulations of the San Joaquin tocol Health,District. Home owner or licen- sed agents signature certifi4s the following: "I certify that in the perForniance of the work for which this permit is issued, 1 shall not employ Any person in such manner as to become subl714� t to Work Compensation laws of California." Signed -------..._ ZvL Ir �_ _-----•-- _ ----...--- Owner - -W� } _____________________ jitle {If otFie��thanl owner}� " �,:► - -.s.;..•; - ��'_ L�� U�2 r.. -��Cl.��. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 9Y .._7rtR-3.►.._- - . DATE.....w `.' -��_.........- BUILDING PERMIT ISSUED'_ DATE . .................................... ADDITIONAL COMMENTS !L..................... i�. I -------------- ----------------- -•--••-•--- ----------------------------------------------- -------- ...... --•--••------- ............ ....... ........... ............. ........ ._.. ._ ... . - Fina) Inspection by: .. ._------- _......_-............. ....... •--.•----..._._.. .......Date _. _..0. �. m'_ ............ EH 13 2h 1-63 v. 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M