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ArrLIGAII.1014 FOR SANITATIOR V'6 i1Y 75-`3 / ................................................... (Complefe In T€iplitatel F' arsgit No. ..................... ........ ................... ........................ �y This Permit Expires t Year From Date Issued Kato Issued . .....--..•..... Application Is hereby made to the San .Joaquin local Health District for a permit to construct and install the work heroin described. This application is made f compliance with County O dlnance No. 549 and existing Rules and Regulationse JOB ADDRESS/LOCATION .......r. !". . �`� �i � �_ '�" _ .. .. ........CENSUS TRACT ....... -_---.•--- < ff�� Owners Name ..-----•-----....Z L ,C?4�-. . -•---_..... •........... ............ ..............Phone :. l R.....�fC%7...... Address . ...................... _..�K(ft !!'1i ...........City . .0 :F..................................»..- 07� (4. !..1.t .... Phone Contractor's Name -...._._.Lfaetsse# ..__........-•-----• .............................. Installation will serve: Residence NApartment House❑ Commercial❑Trallw Court 0 Motel ❑ Other .....------•---- .......-------......._. Number of living units:------.�'-_-- dumber of bedrooms Grinder............. la>!Slzw --- �� Water Supply. Public System and name ---------------- ------—....... �`__ �........-------•._.. - ........................._•................Private Character of soil to a depth of 3 feet: Sand❑ Slit❑ Clay ❑ Past❑ Sandy Loam o Clary loom Hardpan ❑ AdoUe❑ Fill Material .-- ..... If yes,type —....................... !Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed or: reverse side.) NEW INSTALLATION: {No septic tank or seepage pit permitted If public sewer is available within 200 feet,} PACKAGE TREATMENT [ J SEPTIC TANK{ J Size......•-----------------------------............ Liquid Depth .......................... CapacityType _» Maden ...................... No. Compartments -...........-- Distance to nearest: Well .........Foundation ...................... Prop. Line ............»-..--- LEACHING LINE [ J No. of Lines ........................ Length of each line............................ Total length ............... 'D' Box ............ Type Filter Material --------------------Depth Filter Material .....................................»....� Distance to nearest: Well .....................;.. Foundation ........................ Property Una ........................ SEEPAGE PIT { , Depth Diameter ................ Number ............................ Rock Filled Yes ❑ No ❑� )Nater Table Depth .............»-................................Rock Size ................................ Distance to nearest: Well ........................................Foundation -------------------- Prop. Line ..................»7- REPAIR/ADDITION#Prey. Sanitation Permit Date ----....... Septic Tank (Specify Requirements) --------- �� _r� �f: _. ........ Di s / ........ Doss) Field (specify Requirements) .---... ..- - --- ..................................._.........--------•-------•----•...................... ................................................ ----------- ..............................................--•----------------...................-----------•--.....,...................... ......---•-.._......I ..............•••------•-------...------.-----.........-----•----•----••-----•-----..........---•-----•-----------------...------......._..----•-•---------••..----..........------•--------•-. (Draw existing and required addition on reverse side{ a I hereby certify that I have prepared this application and that thc-.� zirucl? wllf be done In accordance with Son Jewlein County Ordinances, State Laws, and Rules and Regulations of the Starr ,ieaz:uip Local Heattk.. District. Holm+ owner or )icon- � sed agents signature certifies the following: "I certify that In the performance of,the wore: for which this permit is issved, E i4tall not employ any persona in such manner as to become suFij tc Work &6impensation laws of California." 7 fined .......... ...... ....... Owner By . -. .... .............. --- Title If other than owner) _ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ...... ......... ..: f . .. .............................--................................... DATE BUILDING PERMIT ISSUED .....-. .................. ..........DATE ADDITIONAL COMMENTS ,.0��?5 ...-. *-4C-a-------.•-_--�.- ---------------- ----------•------- ----- - .-. ...---.......................- ,�. --- ----------- y.�.--.........I.........•• .. . ......... �......... Final Inspection by: ... .. .: i.--•----- . ........ .......Date .. ............. )~il 13 2!r 1-6ii Acv. T ,, � ��..�. .._..... SAN JOAQUIN IOCAL HEALTH DISTRICT 8/711 3M