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FOR OFFICE USE. APPLICATION FOR SANIT'.TION PERMIT 7 Permit No. - (Cams .s•In Tri..licote) 7 �r/i3 Date Issued / " This Permit Expires 1 Year From Date Issued and e work h- Application Thisapplicationso the San Joaquin Local HecIth made in compliance with Countytrict for a Ordinance permit and existing Rules alndhRegulations: 1n JOB ADDRESS/LOCATION �•7�7 r� 7t1,r5,r_1,101 CENSUS TRACT . Fi('l51 N�� /J 0 s eL— Phone Owner's Name - � � __ g City _y-z��l�rr. . ... .... Address / �7 M. N�%/{/ . ...... p �/ 4 b Contractor's Nome J[Ct .��P�� •��/" -- - License # �. Phoria Installation will serve: Residence C.)Apartment House❑ Commercial iKfTrailer Court ❑ Motel ❑Other .... r r lt0. . . .. ...... Number of living units:— Number of bedrooms .�....Garbage Grinder Lot Sire /or. � -r3 ..... ................................. ........ ...Private C3Water Supply; Public System and nc.^,e - ....-......-- -�- �� '�- PP Y: Character of soil to a depth of 3 feet: sand❑ Silt I-] Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Haropon❑ Adobe Fill Meterial If yes,type (Plot plan, showing size of lot, locntion of system in relation to wells, buildings, etc. must be placed on reverie side.) NEW INSTALLAIION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) r . Liquid Depth . .............. PACKAGE TREATMENT 11 SEPTIC TANK[A size.Q..Y.Z-.X.S ,.y- q rc6;�lLT �' uSTMaferia �/F No. Compartments 2.................r CoPacity �. YPe �/7� r r r -. .. Pro Line ..� .Foundation .. /�.. .. P• ... ...........' . Distance to nearest: `Nell ��----••----•-� r LEACHING LINE {(t No. of Lines _7 .. Length of each line 9C r - - Total Length ,5� r�..C............... 6 'D' Boxy.S Type Filter Material .. �..-Depth Filter Material .IQ. - ••..-.. ..-••••••••- r r . Pro Line .. _................ Distance 'o nearest: Well �n�.. .- _.... Foundation .._.�L!- - - perb SEEPAGE PIT [ ) Depth Diameter .............. Number Rock Filled Yes ❑ No Q semy,. e`ester Table Depth ................ Size .__.... _.. .............. I ... ................. Distance to nearest: Well .. .............Foundation . . .. .......... Prop. Line ...................... {' REPAIR/ADDITION(Prov. Sanitation Permit# .. ..... .. - Date .... .....I. . ................ .I Septic Tank (Specify Requ:rementsl ._.. _. _._. .. .. ................................ ............ . . Disposal Field (Specify Requirements! - - .... .. -' -' " ' "- - "'--" - . ............... .- _. ... __. .... _......... .._._.........__.. . ._..... ...... ...__......... . ......-........I............. _._. ....... _...............__. _ ... ................... ....... (Draw existing and required addition on res -.aside) 1 hereby certify that I have prepared this application and that the work will be dens In accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the Sen Joaquin Local Health DisMct.Nerve owner or Rao- sed agents signature certifies the following: "I certify that in the Performance of the work for•vhich this permit Is issued, 1 shell net emPioY any Posen in such manner as to become subject to Workman'•:;ompenzatior}laws of California." Signed /[� ..... ... . Owner .. ........ .. /� Tsstt title C(.;/yfBy ./c. (If other then o rl OR DEPARTMENT USE ONLY - APPLICATION ACCEPTED BY o- /`w .h.s _. . .._ DATE - DATE BUILDING PERMIT ISSUED - - - is-- '- ADDIpONAL CCM6 NTS F .. - ... - ? .1 _... fi E Final Inspection by: UIN . . Uate 3/Z7 / fN JII locAl HEALTH DISTRICT i i N. 9 1.'68 RLr+.