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� CE"USE: , ..... APPLICATION ICOR SANITATION PERMIT :�.':...._........................•---..1.._...I...... 1Compf0ein Triplicate).' . .......................................................... 'Chis Permit Expires t Year From (Date I.ssg&d Date Issued Application is hereby made to the San Joaquin focal Health District for a permit to canstruct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Reguttttions: JOS ADDRE ' SS�LOCAF;ON ...��. I_.�P-_./._.:....:/�-•---��-�S�.nC....__G.4-�10 .......................... SUS TRACT Owner's Name ...CEN Address Phone .. ..:................. ..................:...:..... ... . ... .e � :..�a - ..... ..... city Q Lv Ia/�1�, ...................... _ Phone �.l.� � Installation will serve: Residence❑Apartment House❑ Commercial❑Trailer Court ❑ Motel - Other----------------- . . Number of living units:...$ _ Number of bedrooms �C.....Garbage Grinder ; ---• Lot Site Water Supply.. .........•. PP Y• Public System and name Private Character of soll to,a depth �.._........'............. p of 3 feet: Sand Silt o Cloy ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan P 0 Adobe ;!f 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.{ NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer-is available within 200 feet,) i PACKAGE TREATMENT f SEPTIC TANK{ ] Size......: .................... ............... Liquid Depth capacity ....... Material ��'te �. No. 'Com Z T 'Compartments Distance. to nearest: Well _......_._ ...._::.Foundation ...... ' ............. Prop. Line .....................6 LEACHING LINE f } Na. of Lines'.............. • ` Length�f each line.......................... Total Length 'D' Box............. Type Filter Material t.. .............. .Depth ,Filter Material i Distance to nearest; Well Foundation .,.t ...._ Property Line ... i SEEPAGE PET ............. �IT O Depth ___d��' .... !Diameter ...IIZ':`---- Number .......**Z-................ Rock Filled Yes g]-- No L]� Water Table Depth ................................................stock Site � •� -� Distance to nearest Well Wel. ...................Foundation ---1.G.':...._.. Prop. Line �® / D REPAIR ............. 3 t /AbDITION(Prev.(PreySanitation Permit 1..7.. Y,�., . Date Septic Tank !Specify Requirements).............. ....................... .............. ... Disposal Field [Specify Requirements) - �y X ...... _.. .... e.e►f ...... -------------------------------------------- ------------------------------------ --------------------- --•--... ................... -••-•---•- ----------••-•-.........--- (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 San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District, Home owner or licen. sed agents signature certifies the following: "I certify that in the performance of the work for which this p ermit Is issued, I shall not employ any person In such manner to becomes ct to Work 's C ensation laws of California." Signet:, .... .............. Owner BY .... ----------- ....................... .. _... .---•-----D._LC��.,�/� ,. • (If other than owner) Title .................................. DPARTMENT LtSE ONLYAPPLICATION ACCEPTED $UiLDiNG Pi=EMIT ISSUE© •---••••. •-••---•---•-- •- ------------------------ DAT .............. ADDITIONAL COMMENTS CKv, ,_... ;•-----�-DACE -;.. .--•---. - ------------•-------•-- .. .......... .....-•-..,,.-•-•• ................................................. ....................... ........ ............ ..' ...................____--__._-.-__.._._-................------....._..._-....._...... _ _ Final Inspection by: �G_GP- � (�; .. � EH 13 2b 1-68 Rev. ---------------- ••-------------------------------------------------- - ------ --- - --•- -------.Date ..1 . ? SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7� 3M 1f2 //?j