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FOR OFFia USE: ............... . APPLICATION FOR SANITATION PERMIT ICemplete in Triplicate) Permit No. This Permit Expires I Year From Defib lewd Dab Issued . -.:1... -7L Applkotion is hereby made to the Sun Joaquin local Health District for a permit to construct and Install the work Renk+ described. This applicis madgn compliance with County Ordinance No. 549 and existing Rules and Rpulatlom ation JOB ADDRESS/LCT 3 j....... ... . pr'` TRACT .... . ....... Name ��' / ..... _... ..... . .. . Owner's N ��l r:.�J.P�a'f f � , Mane . .. . . . ».. Address /?D � . . ./l 1.a .... ...... ... ................City 3� A e.(`- ' ... .9S 2.0 Contractor's Name ..... .. . ............................................License♦ ......I ................ Marty ...... .................... Installation will serve: Residence❑Apartment House C3 Commerdol QTrollw Court C Motel❑Other. .L.4 i✓'...Ca..w.e..... Number of living uniri: . Number of bedrooms ............Garbage Grti'nder .. .. ...... Lot Sin .... ....................................... Water Supply: Public System and name ................................»......................_..................................................Frlvofe ffi C"horoctow of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peot$g Sandy Loom(3 Cloy Low Q Hardpan❑ Adobe Q Fill Material ............If yes, type............... ............ stem in relotion to wells, buildings, 1 Mot pion, showing size of lot, location of system ngs, etc. must be placed on eoveeee tilde NEW WSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 400 feet,) PACKAGE TREATMENT ( J SEPTIC TANK VT S12e.,4)c X t' t S> x iJ . Liquid Depth ........�. .......». Capac N7.y ..... Type P/r:co�f Material.[ .m-ry.r.?? No. Com ........ .. .. Distance to nearest: Well .. ..I44. ..........Foundation....;;?!.L.d........ hop. Vete.. .. ....»..... LEACHING LINE O No. of Lines .. Length of each line.... ....................... Total length .........................». 'D' Box Type Filter Material ....................Depth Filter Material ............................................ Distance to nearest: Well ..............1........ Foundation . . Property Lite ........................ IT ( ) Depth �f ....�.......... Number G.... .7.�.......... Rodt Flll Yes j3 No Q Water Table Depth ..................G............. Rock Size .... Distance to nearest: Well ......... b" ......... .� ............ ..Foundation ......?/..U.. Prop. lute .... .?...:5........ REPAIR/ADDITION(Prov. Sanitation Permit# ........................................... Date ..................................) SepticTank (Specify Requirements) .. ...................................................................».........................................._................. DisposalField (Specify Requirements) ........................................................ .......................................................................... .......................................................................................................................................... (Draw existing and required addition on reverse side( 1 hereby certify that 1 have prepared this application and that the work wifl be deme In dcconhoce vA1% far Joogvbr County Ordinonces, State Laws, and Rules and Regulations of the Sam Joaquin Local Health District.Home owner or Neew sed agents signature certifies the following: "I certify that in the performance of the work for which this permit Is Issued, 1 shell not emspley any persen In strut tssatsser as to became bled to Workm 's Coinpeli4ation laws of California." Signed �r-t- I'll- C 1. ......................................... Owner By (If other than owner) USE ONLY APPLICATION ACCEPIED BY _ DATE /low// ?� BUILDING PERMIT ISSUED _ DATE ADDITIONAL COMMENTS r Final Inspection by: %i,_.r` ./.` /IJIN `¢"� .. . . _ Date �� 76; EM 13 2h 1-611 Jlcv. rm SAN JOLOCAL HEALTH DISTRICT 8/7h 31'1