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FOR OFFICE USE: APPLICATION POR SANITATION PE, .IT • Permit No. .71-.7-�l•Q ....... ................................................ ' Itlremplate in TrfpBmfd ............ ..... ...................................... .. Date Issued :.�-2..:.�. This Peneit Expiles 1 Year From Deb Issued ......................................................... Application is hereby made to the Son Joaquin Local Hec&h District for a permit to construct and Install theworkherein described.This application is made in comm�pplionce with County /I Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LCK:ATI� .IQQ��fz. ./[o: ...:l J� ✓:.. . . CENSUS TRACT .......................... ... .... ... . ..... 2 ..... Owner's Name +P. .. CG_ ,ter ........ ..................... ............ ........Phone _'�l'�-4.. . .. . . Address .... ..i0 City ...... .................................................................. '..... W6-9dfQ.'I... Contractor's Name......� - �"�""�� x,Svyr� ...... ....License#/��..._ Phone Installation will serve: Residence❑Apartment Hbuse[3 Commercial Trailer Court.❑ . Motel C]Numbrf living un u berof bedrooms ............Garbag Garbage Grinder .. . ... Lot Size ....Q ---...---.-- WateSupply: System and me .................... . .. :::: . ............. . .. -- Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loom ❑ Hardpan❑ Adobe 5q Fill Material ............If yes,type.................. (Plot plan., showing size of lot, location of system In'relation to wells, buildings, etc. must be placed on reverse side.) V NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) d PACKAGE TREAiThENT [ ] SEPTIC TANK[ ] . ' Size.......................... __............:.... Liquid Depth ..__.................... Capacity ......... _.... Type .................s.. Material------:............... No. Compartments ...................... Distance to nearest: Well ....................................Foundation ...................... Prop. Line...................... LEACHING LINE [ ] No. of Lines . .. ....... .-. . Length of each line........................... Total Length ............................ . . . . 'D' Box ............ Type Filter Material ....................Depth Filter Material :........................................... Distance to nearest: Well ........................ Foundation ........................ Property Line .................. SEEPAGE PIT ......... ...... \ [ ] Depth ............ ...... Diameter ................ Number .......--.--................ Rock Filled Yes ❑ No Water Table Depth ---.......................................:'--.Rock Size .:-....:........ ............P. Distance to nearest: Well -........I...._.......................Foundation .................... Pro Line .................... REPAIR/ADDITION(Prey. Sanitation Permit# ........ ..................._.............. Date ..................................1 \^ Septic Tank (Specify Requirements) ..._._. .. _ :. ...-. ;.. T �' v . - ?-... - `) Disposal Field (Specify Requirements) - - ... -" -" --' - - - - _. ...... ......................................----------...... _..._.. ................... .......... _.. _.. _...... ..... _._.................. .......... (Draw existing and required addition on reverse side) I hereby certify that I have Prepared this Wlicatian end that the work will be done in accordance with Sen Joaquin County Ordinances, State Laws, and Rules cind'KeIijulathsas bf the San Joaquin Local Health District.Home owner or Ikon. sod agents signature certifies the following: "I certify that in the performance of the work for'whith this permit is issued, I shall not employ any person in such manner as to become subject to Workman's Compensation,laws of California." wrierSigned _ . ..... O BY _ ._......... .Title ._ _... ..... ......... 'ii ter (If owner) _ -- F,.�O;R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ��'`-"'�— .. ...._..... ......... DATE .. . .-..2G �L..__ ...._ BUILDING PERMIT ISSUED .. .. . ._. . . . ... ..__ .......DATE __....-_............... _.._.__.- ADDITIONAL COMMENTS final Inspection by. � 7 �� -�-- �-- - �- Date .O SAN JOAOUIN LOCAL HEALTH DISTRICT E.H. 9 1-'66 Rev. 5M