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FOR OFFIrV USE: .....-.................... APPLICATION FOR SANITATION PERMIT ..- (Cemptefe.in Triplicate) ....__._.__ Perrrrit No. .-..-.._._ �•._ ......................................... ThisPorar nrltExpires1YefromDafeIssued Date Issued . _7�' MW Application is hereby made to the Son Joaquin Local tlealth.Disoict.for a permit to construct and install the work herein ; described. This,application is mode In�gcompliance with County Ordinance No. 549 and existing Rules and Regulations. JOB ADDRESS/LOCAT ON c`a4 .L- ......- Qr! 'LGFG�.:. Cf 1....................: Owner's Name � G rb-�S'R/....._.. ....._............ ........city ./.. eE-`f...CC�I5U5 TRACT ....:. -._...-.--•-• Address ....>" ContractoisName'.... ,(p -. G��eT! .-•------.......................ikense,oQesl4sGW-. Phone Installation i ill serve: Residence Apartment House Commercial&raltik4uit I] Motel•O]Other..........T ...... t units: .. Ir Number o£ living n, \ g `----- Number of bedroom -._�..._ rbage Grinder� Ioi,SPze Water Su < Public System and nomi ._ PPY1 Y ..._ . - .. .'--- --;__Private d CharocEer of soil-to a depth of 3 foot: Sand L7 Silt o Clay p Peat Q-,!gfn*Loam o Clay team$d �. fHardpon d Adobe o -Fill Material ..............If yes,type=- ,t a.. (Plot�plon, showing size.of lot, location of system in relation to wells, buildings, etc. i ust be placed of reverse side.) N W INSTALLATION: (No septic tank or seepage pit permitted if publig sewer is available within 200 feet,) / v PACKAGE TREATMENT [ ] :SfPTIC7ANl: Size:7..-�(X1. --...--.:-_.-... Liquid Depth ` Capacity pc�f�G?:.-.:_ Typo Mwerial .No. Compartments i - _ - U Distance to nearest: Well .....-as',!-„...................Foundation --,1,s��......----__ Prop. Line /.1;U4..?1�__..... LEACHING Llh!E4T$- -bLof Lines - -.-Y! Length of each line ----------- ._.-:-- Tota[ Length ................ D„�Box i✓.��...,7yp`e Fitter Mawriall".40-Depth' filter Material�6..65..................`_.......... :T Distance to nearest: Well .6 .............. Foundation /..�..---....---.... Property line --_--_..•...__. `D SEEPAGE PIT 1 j Depth. ..................` 'D'wmeter-�-`:--"--^'N-5-be'r .-:--,i-,-............--.... Rods Filled Yes 0 No (3 Water Table Depth ... ................1...........--...._.....•Rack Size ................................ �. Distance,to nearest: Well .............. ..........................Foundatlon ............'........ Piop. Line ......--._.--._ ...... , REPAIR/ADDITION(Prov. Sopitotion Permit# ............................................ Date _................................. Septic Tank (Specify Requirements);.... :........ ................ ... ......................•.... .-,................._..._...................._..... Disposal Field (Specify- Requirements) ............. ` ................. ....... { - ... -.................... ........................-:..:.. ........__.---..............................--.................. ............................ .............'........C-........-............................................... _,.- ..--. ... ......... '(Draw existing and required addition on reverse si le) r. ' -^�- 1 hereby certify that 1 have prepared this application and that the work will be done In accordance with San Joaquin' County Ordinances, State taws, and Rules and Regulations of the San Joaquin Local Health.Dlshist.Home owner or licen- sed agents signature certifies the following: "1 certify that in the perforrhAie of the work for which this permit Is Issued, t shall not employ any person in such manner as to become subject to Workmari's Compensation taws of California." Signed _ i t ... ...- Owner By .....:_..........-- - - .... Title -d�-�`'.. er than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ..,, J�;:..._ _.._-.-. ......DATE --:_. --.`/T,---Z .__.....:..: BUILDING PERMIT ISSUED _........ ........................DATE _...................-.....,............... ......................................................................... ADDITIONALCOMMENTS ...... .. ........... ..-..--...._.-.... ......-...--.-..-..._-....._..-_....,........_...... _._.........-• ........................... ............_......-..... --- ---"------ . . -- _ .._ .._ .......... ......................................................... _ _ ...... .. .. : ... . . .. . On Ins coli• - ........................................ .......... p' � ... ... ...... .........._..._.........-.:.......Date .. .._-.. ...`.........................EH 13.211 1-6f3',_ Rev. 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M i