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' _ ", •r, ., .�., . . ,,..;i.,��ti:a•a>c�.w'!e:eS':.a�:;;4d�y�a,r�azv:•ski;ry,L-:�•..!i,.,;,'«....:Y'��.1°J�:�4.9...wAS4.'.'....�. . • r "Y FOR OFFICE USE: feAPPLICATION FOR SANITATIC°,.4 PERMIT " ................................................... Permit No /0�7� afzY (Complete in Triplicate; Date Issued'....................... This Permit Expires 1 Year From Date Issued .��%�� Al Trlii Applica*ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein i described. This application is made //ii'n compliance ith County Ordinance No. 549 and existing Rules and Regulationst JOB ADDRESS/LOCATION .... .......b �._..!�-' L� k1 /y �... ,. - .. CENSUS TRACT, .. Q. Owner's Name ................ . . ..... Phone Address Ci // hon ' ._....tv-S .. . .....t... .......-- .-.._.- Contractor's Name ............ �/✓f ..... _...SG ................License#1.ft• -,f/-y:. PhoneC 4.140. Installation'�vill serve: Residence Apartment House Commercial ❑Trailer Court 0 _. Motel ❑Other.... ....................................... ( < Number of living units ..... Number of bedrooms ..3.....Garbage Grinder ............ LM Size % Private Water Supply: Public System and name ....-----•........................._....._-.-....--•---._.....----..... ........_.... :.:._..---... Character of soil to a depth of 3 feet: Sand j] Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ r`�S , ,,^ :, Hardpan❑ Adobe ❑ Fill Material........:__If yes,type............ .....:.. i s rI (Plot pian, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse 'side.) ` f NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) ; } PACKAGE TREATMENT (•] SEPTIC TANK�Q $�ze ::_ }",,.��5 : Liquid Depth P Capacity::1ZG0.__.... Type......... Material..:4!r?vL. No. Compartments" -"Distance to nearest: Well .....1 ................ Faindation :Prop line : 7 LEACHING LINE No. of Lines ..::_...22 . len th of,each. Irne .. y t r ' ......... g .._... Total Length ter. �c}Q D' .Box ::1/.-. Type Filter Material. . ..Depth Filter Material ' ./? ............ Y¢r rTy Distance to-n-'ea rest: Well -..1.4???..1`.'.::J.Foundation ......... Property Property line u r . SEEPAGE Pit O Depth _-Diameter _..._ _...:•-Number :.:: ............"�! r ijRock Filled Yes ❑ .No C Water Table Depth _... --........I............... ..Rock Size ....:ij It i Distance to'-nearest: Well ........ ..................Foundation ................... Prop; Ltne s ' REPAHt/ADDITION(Prev. Sanitation Permit# } p Date .. ... �r :Septic Tank (Specify Requirements) .._....:._:._._...__. / . -... .- L 7�}R� � ..._.. ------ fDisposal Field (Specify Requirements) .............................:_..7._._.....:_'.._:...... -' -___....: ......................................•-'•'•••-••............. . .. .. :: 1 y (Draw existing and required addition on reverse side) i _ r'7 �'��..' �. I hereby certify that I have prepared this application and that the work will be Bona in accordance with San Jeaqui ` County Ordinances,.State laws, and Rules and Regulations of the San Joaquin local Health District.Homeowner or liters-r`A i sed agents signature certifies the following: I ? 'I"certify that in the performance of the work for which this permit Is issued, I:shall not employ any person in-such manner a} +. as to become subject to Workman's Compensation laws of California." i < Signed ......................................... Owner x i BY Q, Title �� r I t - ' ( f other n owner) ti J�N z f hr ' r5 : FOR DEPARTMEN U,SEiONL �.► �T APPLICATION ACCEPTED BY...:......................:.................__ ._.___... / O 1* .. .... . .... ...•- __.._:_: DATE....../6. s�r�-.7 a. BUILDING PERMIT ISSUED. ...........................................•---...... ......... .. ....... ......... ...........DATE.........: " z ADDITIONAL COMMENTS_:_..............' ............................... - ..._._......_..:_........•..................::.......... ......... .....: _ - jt ...................... .........................................................................'.....`....... Final Inspection b .... '-� .. r it PY�-�..:: .. ........................... ... •._ /• -,ly-�.. .Date.: ...... ! :... SAN JOAQUIN LOCAL HEALTH MTRICT E.H. 9 1-'68 Rev. 5M C ` iilirY� -,'rrr