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FOR OFF=ICE USE: � L L. APPLICATION FOR SANITATION---PERMIT � ----- ------3------------^------------------------ ------- Permit No. ----- -=---------- (Complete in Triplicate) { ------- -- ----------------------------- . Date Issued This Permit Expires 1 Year From Date Issued l .� 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'. 54�"and existing.Rules-.and Regulations: JOB ADDRESS/LOCATION ._ _-- -- --- -- _� .... � '-_~CENSUS TRACT ------ --=------------ 44 Owner's Name - � N- -1 _ 1�• --�-� ` Phone. .s ---- Address ----- - - _ 4`� J<- ---------------------------License ��(vNTEK� � Contractor's Name -H14F1 EFP-----> �J .�------------------- --- Phone installation will serve: Residence ❑�Apa'rtment,Hoose1[,]� Commercial❑Trailer Court, [^ Motel ❑ Other' ---- ----- k i ! s Number of living units.__3±�__ Number. of bedrooms _- ,V.Garbage.Grinder _.' %'___ Lot Size - - - Water Supply: Public System and name -BEHAK------- �� -� p Qt S Loa Clay Lopmrivate El Character of soil to a depth of 3 feet: Sand ❑ Silt 0 Clay El ❑ Y LTJ �. ❑ Adobe ❑ Hardpan AdbFill Material -__R�G� If yes,type ___-_-_-'_._.- P _ (Plot plan,\showing size of lot, location of system in relation to wells,sbuildings, ;etc. must"be placed on reJerse side.) r � NEW INSTALLATION: (No septic tank or seepage pit Lermi ed ' yblFc 'savailable withi b0 eet,)b �PACKAGE TREATMENT [ ] SEPTIC TANK'[-] Size_M1Q')_=-i_H0--�.--=---------- --Liiquuiid#Depihh ._____-?-___-__-.-_______- r fi ' f �fii / �Capacity _ OO6--- TYPe ----- a -------Distance to nearest: Well ------- ---- ---------- n_Foundation ------------'/�--_ Prop' Line _- ------=7---...--- - - % LEACHING LINE \ No. of Lines ------------------------Length of each li e-----_`:_,-_ ' Total Length '____-_... _ __- � , t SVD' Box ------------ Type Filter Material ---------------------Depth-Filte-f"Mdteriai ---------- --------------- -�------ Distance to nearest: Well :------ _ ---- Foundation -----------------=`:--- Property Line ____-__________,----.--- SEEPAGE PIT [ Dep h -----�----------- Diameter P_.3_ Number,--_---- ----------;-_-�`'Rock Filled Yes No 0 Water,Tabie Depth -------------------- --Rock Size - -- --- ----- - - ---------- Distance.to nearest: Well -- _.___�'`____ ___ =� t`Q_,__ F+;undation -______-__ _ p. ; �La:- Pro Line. (Prev. Sanitation Permit#,,_`' '^ `- ------------ Date ) , 4 Septic Tank (Specify Requirements) - ------ .= i ------`-v`------- k----------- ------------------- ----------------------- --------------------------- � Disposal Field (Specify Requirements) ----PIT- --------- ---X--� - 1 f x. M: r - -___--�` `_ Draw exist g and req d t on o evY-Br ide _J 7 _�_ _--------- I hereby certify that I have prepared this application and-that the work w�ll._be_,done �n__;accordance with San Joaquin.,_ — County Ordinances, State Laws, and Rules and, Regulations of the San Joaquin Ldcdl Health'District. Homeowner or licen- V sed agents signature certifies the following: �•� . .- , ' "I certify that in,the performance of the work for which this permit�is issued, �cll not employ any persona in such manner as to becom subject to Workman's Compensation la sof California'." # Signed d' ' O ner ; BY � JfIE./ .-+r` = ---------k- TiNe ._ _ - -- ------------ --------- (lf other than owner} FOR DEPARTMENT LISE-ONLY 1 ` APPLICATION ACCEPTED BY ------ --- -------------------------'--------- --�- ----------------------------- DATE -- � ---�•--� ---.------- BUILDING PERMIT ISSUED ------------------ ---------- ;--------------DATE - ADDITIONAL COMMENTS --------- ------ -- ---&-- �:-------- --------- ---------------------- --------- -: ------ ---------•------------- ----- - ------ ------ - _ - ------- ---------- - ------- --- ---- ----- -------- --- k Final I ection b : - Date ------ SAN JOAQUIN LOCAL HEALTH DISTRICT f E. H. 9 . 1-'68-'9,ev. 5M' 1