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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT .. ........ . . .. . ................... Permit No . ..... (Complete In Triplicate) r. �.. Date Issued ........................ . This Permit Expires I Year From Date Issued T Application is hereby made to the San Joaquin local Health District for a permit to construct and install the work borein f. described. This application is made in compliance with County O trance No. 549 and existing Rules and Regulation, s?' • g; JOB ADDRESSAOCATION I C.Z..j,.. .r....... �aLac..c,.�• .CENSUS TRACT . �y Owner'& Name- .......Phan . 9 Y� ..... '�y ....... ..... - ....... A Address ...LO.. ..Z6 ....ado /.t��... ......... Gty . ` c..Gei�-4+*....:..... "J Contractor's Name. y ......... . ............. ......... . license ��.9a7f.. Phone �da ..703 . - installation will serve, Residence IU Apartment House 0 Commercial ❑Trailer Court D ( ' , Motel[ Other .. ............ .......................... NumEer of living units:..-/...... Number of bedrooms ..{r gGrinder ....... .,;J......Garba a ..... Lof Size ..� .... �...... f -: Water Supply: Public System and name . . . .......................... ...... . .......................................................Private d Character of soil to a depth of 3 feet: SondR Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam❑ t( Hardpan❑ Adobe ❑ Fill Material .. .. ..... If yes,type............................ N` (Plot pian, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side) a t• NEW If 3i PACKAGE TREATMENT NT [ )a sSEtPTIC TANKAI page pit permittedSize ..7Public sewer is available�X.��6�4 t«�. ....withind2D feet) L4�" t Capacity ./GDa...... Type ... Moterial..41P.P� No. Compartments . - Distance to nearest: Well .1...�.�..............Foundotion.. .Id ...... Prop.Lin LEACHING LINE k1 No. of Lines Length of each line. IA60.O............ Total length ...`. /D ' r ' 'D' Box .... Type Filter Material ..*...Depth Filter Material ............/..9 r r - . i k, - _ Distance to nearest: Well .....��......... Foundation . . Property Line �....... SEEPAGE PIT [-) _ Depth. ...... ............. Diameter ............... Numbe- . ........ ..... ........ .. Rock Filled Yes ❑ 14 Q Water Table Depth ........... . ............................ Rock Size . ...... .................... y. Distance to nearest:Well ... .. .................................Foundation Prop. Line ........._........ n REPAIR/ADDITION(Prev. Sanitation Permit#......... ... ........ ......... . ..... Date ............. ....................I SepticTank (Specify Requirements) ........._..........................................Q. ................ ....._........................_............._................ Disposal Field ISperify Requirements) ...........11pLJd ftLt.... . . � -! -............................................. .: .........................................__.._........_................... 14................ ......._.......................... ... f. ................. .........................._... ....._._................................................_...._...................................................... .............................. . IDrow 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.Hems, owner or Mao- sed agents signature certifies the following: "I certify, that in the performans of the work for which this permit is Issued, 1 shall not employ any person In such manner as to become subject to Workman's Compensation laws of California." Signed . . .... ..... ... ..__ .. .. ..... Owner q - �I By.....LJ . ___ . . .. ._. Title . (�6 1. ... .. ............... .. (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ........7..........._ _. _..:......._................ DATE __........ .7::. 2 ...... BUILDINGPERMIT ISSUED ............. ............................................... ........ ... ............... ..............DATE .......................................... ADDITIONALCOMMENTS ..........._........... ............................................... ...__ .........._.............._.................. .............................. .. .............._...._.... ._.................__....._................. .. ...................... ......................................................... .. ..__._ ..__ . __.. ........ ....__..... . .. .__._ ..........,.. __.. ._.__ . ._. ..._._. ...... ... . ...... .. .. .... . ....... Flnol Inspection by: _......G?`/ 0 ... .. .. .... .._...... .. ._ .Dote . 9' G. 2........... SAN JOAOUIN LOCAL HEALTH DISTRICT E. H. 9 1•'68 Rev. 5M