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FOR OFMCE UsE �rsAPPLICATION FOR SANITATION PERMIT d .. . ... .. ........................................ (�omplafe inTrigfiicate} Permit No. ... . - ....................... ................ This Permit Expires Year From Oat*Issued Data Issued ....... 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. 544 and existing Rules and Regulations, i JOB ADDRESS/LOCATION .......r« O_.....W......P'49.j t'GC7..................................„ ......CENSUS TRACT. .......................... Owner's Name ....... !�G K.. C .� �.!�! !!'C ..................................................................Phone .. ? .. Y3 ._. Address f.�f"!0.. ty j Contractor's Name 'r...l9/�►74it11�' 7�' Sf�je� _.License # ... Phone Installation will serve, Residence❑Apartment House Commercial❑Trailer Court (7 Motel ❑Other_.► G' J_10M'c : r.. R V.-J4c.A Number of living units:.....1-..... Number-of bedroom ...�-----Garbage Grinder -------_.- .................................. -- Lot Slxe .... ..... Water Supply: Public System and name ...................Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam IN day Loam 0 Hardpan❑. Adobe❑ Fill Materlal ............If yes,type ............... ............ (Plot plan, showing size of lot, locatlon of system in relation to wells, buildings, etc. must be placed on reverse aide.) f NEW INSTALLATIONS No septic-tank or seepage pit permitted If public sewer.is available within 200 feet,) PACKAGE TREATMENT [ SEPTIC TANK ....................... Liquid Depth ....`� .----•------... Capacity /°�� Type 'c Cast” Material..Co, No. Compartments Z is •--- ................ ..............-•-• ------......-. ...10 ` I" Foundation 6 ` ... Prop. Line �a............0 Distance to nearest: Well .--.baa....................... ..--••---•--•-•--- LEACHING LINE a No. of Lines -......;Zr------------- Length of each line........ a................ Total Length Zof14`................� I: 'D' Box ...... Type Filter Material .. ?��......Depth Filter Material ..� ................................... Distance to nearests Well .. d0�. . Foundation J� � 3�a ........ .- Property Line ........................ ; 4. SEEPAGE PIT ( g Depth .... ............... Diameter .... Number ------------------------ --- Rock Filled Yea ❑ No 81 Water Table Depth .._Rock-Sizs Distance to nearest: Well ....Foundation '. Prop: line !REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date .-------------._.-._...--.--------) SepticTank (Specify Requirements) ...............•-•----................... ---................. ..............................I........_. .».......................... Disposal Field (Specify Requirements) ........................................................................................................... ....................................................... -•---•---- ........................_..................................•......,................................I............-............ .... -••-•--------------------------•--•----•--......... ......................... .................-..................................................................................... ...... (Draw existing and irre uired addition on reverse side) I hereby certify that I have prop ar ed this application and that the work will be done In accordance with San Jo! ` • aquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Hoche owner or licen- sed agents signature certifies the following: "I certify that in the performance 9f the work for which this permit is issued, I shall not employ any person In such manner as to become subject to Workman's Compensation laws of California." Signedl'. ... ... ..... y-----------........................ Owner BY J --I............................• ' Title ............................... ............................ ........... (if ath er) FOR DEPARTMENT Ug'ONLY APPLICATION ACCEPTED BY ... ...... ........ � . .. ....................... DATE.;....... BUILDING PERMIT IS SUEDDATE .................................. ........ ...... ............... ................................................................................. ADDITIONAL COMMENTS ........_.-.!.............• ._ ...----.._............._............------ ----••-----•-•---- - ...................... .....---.........._..............._.......... .....--•--....-----...._............._....... ........ -... ..... ..................I.......-- .... Final Inspection by;,p_.. ...... .. .. .. ...............................Date . .---.` ...— -.. ._._.... EH 13 2!, 1-611.-°�v 514 SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M