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So. FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. -- ""-- ' - (Complete in Triplicate) �ti_ ....._ ..._ Date Issued .. /,.. >/ This Permit Expires 1 Year From Date Issued Application is hereby mode to the,San Joaquin Local health District for a permit to construct and inslest alndthe work her in Re ulations: d. scribed This application is made in compliance with Count Ordinance No. 549 a e ' i g g � � TRACT ..3 Cc' cy JOB ADDRESS/LOCATION G,{ Phone Owner's Name _. 77 ` . city 'r^�PC2ff..._ .. ...._........' Address l ` �. ✓ ... t �'-_ License #r��/y� Phone 7. .... Contractor's Name - Installation will serve: Residence)NrApartment House❑ Commercial []Trailer Court ❑ Motel ❑Other............. .............................. erd- . Lot Size ..-�..ac��Y_..(, O" Number of living units:_.." Number of bedr s N. Garbage Grind g...". . ts, Private❑ : .....".... ............................ to 4....... -. . .2 Water Supply: Public System and name .........., .✓ -'� peat Sand Loam ❑ Clay Loom ❑ } Character of soil to a depth of 3 feet; Sand ❑ Silt❑ Clay ❑ ❑ y t ............ ...._........ 9 Hardpan❑ Adobe fill Material .....___.If yes,type . t g etc. must be placed on reverse side.) f� ;, (Plot plan, showing size of lot, location of system in relation to wells, buildings, O -- NEW INSTALLATION: (No septic tank or seepage pi perms �vblic sewer :s available within 200 fee oe .. ..- PACKAGEINT Il SEPTIC TANK[ ]'�X� Size.. ..... ... ... Depth __... Liquid D th Capacity Type ............ .. .. Material... No. Co rtm n s .. .. Distance to nearest: Well Pa e ....Foundation Totam Prop L ..... -- ,(y '� . ....._..." Length of each line_....... �� I Length ......llle�--p.......... LEACHING UNE No. of Lines ...._.... /t ,y �) 'D' Box��. Type Filter Material �C"y:'CKS...-Depth Filter Material ...�Z......�........" - /�J Property Line .. g .. ............ .'< Distm,ce to nearest: Well . .. ......-.-r Foundation .... .,_"_," Rock Filled Yes X No ❑ e . Diameter `3'� Number .."..._. .. �. De th �,$.'. ". ..............." SEEPAGE PIT P (��y Mater Table Depth ......Z.Y. ..-�---- .--............Rock Size ....__"....._."..�.. ^^ �CJ Pro Line ...... ............. ' rt, 999 Distance to nearest: Well ..". L>......................Foundation ....... .......... . p- g .v. REPAIR/ADDITION lPrev. Sanitation Permit#......"...._.........._................... Date ............."....................)__ ......................."... Septic Tank [SPecify Requirements) ............... �" �... ___..__ .j - yrr ..1... ... .... ._. Disposal Field l5p cify Requirements) -/ c- ''t" �/ .. ................................ .. .. .. .. .. .. .. .. _ _ _.. .. 'i - "' " (Drow existing and required addition on reverse sidel I hereby certify that I have prepared this application and that the work will be done in accordance with San Jea90 n County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Herne owner or Ilcen- sed agents signature ce,iifies the following: mit is issued, 1 shall not employ any person In such manner "I certify that in tt:e performance of the work for which this per '} as to become subject to Workman's Compensation laws of California•vner b Signed .. .._.. . . ....... .. Owner p _.�._^_-. ._ _ . ... . .. ..... .C.' . . . C Ci? e� By Title (If� it.an owner) _ FOR DEPA MENT US ONLY Baa," DATE S� 3 7 .L(..-_ ..... .. APPLICATI')N ACCEPTED 8 DATE - BUILDING PERMIT' ISSUED ... - - .. -- - - ADDITIONAL COMMENTS .. . - " - / .. .. ... _ . .- _ i.._ Dole nt If" ... .. r[ Final Inspecf.on by x: SAN JOAQUIN LOCAL HEALTH DISTRICT ;39C "� E.H. 9 1-'68 Rev. 5M