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PR OFFICE USE. F ............... ..• APPL11CATION MR SANITATION F � LX,,m,tQ .......................• N PERMIT....._...ICempdete in Triplicate)�. # This Permit } Expires t Year From pato lsstted Date Issued!2 F Application is hereby made to the San Joaquin Local Health District for a described, This app!€cation is made in compliance with County Ordinance Per " t and existing Rules and Re ` permit to construct and install the work herein j JOB ADDRESS/LOCATION ..��SOPf gulations. I�P......:...v�trr.� { Owner's Name --.... D.�1.1!�!�1.1�_.••_._.............. I a SCENSUS TRACT Address........................... I..........._........:................telt 9 -----...! Mt ........17 ....... . �one Contractor's Name __.�S'� ii!T/�p�i ................... City ..............................................._+ .......- . ••.....•.--..license 6-.5"86............. --------------- License •------ - Irtstallation # ..l,fa .. will serve: Residence _Phone S-.t 3 - i ❑ Apartment Housefl Commercial QTrailer Co uit I Motel Other d G f L ' Number of linin---••-......_. �r..... ` g units:._..!-_--•- Number I of bedrooms ..Garbage Grinder •...._.•... Water Supply: Public System and name Lot Size ... -z•2' i.............. f Character .._ ........•......... of soil to a depth of 3 feet: ••..-.-.'-"--'""""-"'_••••••- .-... private gg i. Sand X Sift Clay 0 Peat4 Sandy Laam C] Clay . Hardpan 13 Adobe Fill y Cosi • n Material ,:._........,If ye� s, type .......:......... f (Plot plan, showing s€ze of lot, locat€on of system in relation to wells, buildings, etc. must be NEW lMSTALLATION; (No septic tank or seepage pit permitted if public sewer Is available within 2p� an reverse side.) PACKAGE TREATMENT - feet,y [ SEPTIC TAlWCQ--•---••••- y ._.._._.--•- ....... liquid DepthCapacity !XG• -- Type _ No. Compartme. + _ Distance. s e. to nearest: Well .Foundation .... 120 op. 60 LEACHING LINE .....;...y- ... _ Pr ...... 1 No. of line's a ..................... 0 i Len th of - Lin ----..�..:.f_.. � g sear line._ 'J'!7 ... ...... _.. 'D' Box ....1_..... T -- Total Length � ��............ Type Filter MaterialoGfi' •_Dept Filter Material • ..................Distance to� nearest: Well ' .. .....--- Foundation � . .......... SEEPAGE PIT � 3 De r � t n ..1..:..�...._....... Property I Diameter . .•_. -•---•-•-`..� Depth ...................• ,._...::.---••--- Number �,..� .... ..............._..... Rock Filled Yes ❑ No i❑p Water Table Depth f ••-----•••-•--•-•-...__.... ..................... Rock Size Distance toea n rest: Well ....... Foundation REPAR/ADDI1ION(Prev. Sanitation Perritk Prop . Lina ................................. Date Septic Tank !Specify Requirements) . ...........................� ........- Dis posal Field (Specify Requiretnentsl .................................. •............. ,. •--•-•--•--•••••................. z ............................ jj (Draw existing and required addition on reverse side] .... .-••••• I hereby certify that ! have prepared this application and that the work will be done in accordance with Sen Joe uln County Ordinances, State laws, and Rules and Regulations of the San Joaquin lose! Health Dlstritt. sed agents signature certif€es the following: R Rome awnet or liven. W Certify that in the performance of the work fpr which'this snrnit is issued 1 shall nal employ an , us 40 become subject to workman's Cornpensation laws of California" I �t r P y y perseq in such manner, # Signed ......rt O�_ � ey7A b/t� ----• Y--..... 71 r I ;................. Own er ... TitleBY ------------- 7:11f ------------ iii erl y FOR ARTME T ELSE ONL1t s APPLICATION ACCEPTED B BUILDING PERMIT i5$UED ._.. �`...... -- . ........ --------- .................. ._.__... DATE / ...rC......_. . ADDITIONAL COMMENTS.................. ....................... ._. DATE _ ....................... ........---•.-•--... ........................... `.. --- ---._.-............. Final Inspection by: ~........... _............. .......... .. ... EH 13 2h 1-68 v. Date -... •? . SAN JOAQUIN LOCAL HEALTI-ip15TRfCT 8/711 3M