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FOR OFFICE OSE: APPLICATION •I,OX SANITATION mPERMIT i7No. __-- - ' ICoplete in Triplicate}- Permit --------------------------------------------------------- This Permit Expire L s 1 Year,From Date Issued 76- Date Issued --- -'-------7 v Application is hereby made to the San Joaquin Local Health District for 0--peYmit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and; existing Rules and Regulations: JOB ADDRESSAOCATION 7.3 -- _ -----_ N _-----__ _ ..CENSUS TLIQ RACT ___ ( / , Ph Owner's Name ___--_ - _(;� --L_ on ff. ' _ - e -- ---------------- Address -------- ---- l- - _ llf i t 4= k ----------'�_. City Contractor's Name ----- i ►1 > '--J ------------------;------------------------.License # ------- f------ Phone ---------------------- Installation will serve: Lf1'?Res+dente ❑Apartment Housds-E] Commercial:❑Trailer�t- ;�---� ,-Motel [:)Other ------- ----------------------- Number of living units:------ ___-- Number of be&aoms __-Garbage Grind L/►ot Size � /�- -- - Water Supply: Public System and name ------v----- {-------------t_-------------------- ----- - 1 Private ! = _ y ---------- - Character of soil to a depth of 3 feet: Sand'❑ ) Silt[] i Gay ❑ Peat- Sand Loam Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material k___ If yes;type ____________________________ (Pl'ot plan, showing size of lot, location of system inter ion to welis,W buildings, etc..'must be placed .on reverse side.) NEW INSTALLATION: (No septic tank or seepa if permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANKol"6 `, a� tr Size_b l liquid Depth : �------------ V Capacity � Df�_-- Typef R 1'1Material__-C��C-r_-`�No. Com artments Gl f / t p -- stance to nearest: 'Weil :?L :-__---.Foundation A9------ Prop. Line LINE [ No. of Lines ------ ----- Len th of each line' r t LEACHING L_ Length Q Total Length ------------- 'D' Box ------------- TY6e Filter Material -------Foundat epth Filter Material -------------------- , Distance-to_near4t:-Well_.�------------- ----- on ------------------------ Property Line ------------------------ SEEPAGE PIT [ ] Depth -------------------- Diameter -------------- - Number -- _-._._-_-______.__ Rock Filled Yes ❑ No i❑ i ' �., , Water. Talsle Depth ---------=--------Rock Size ------- �� Distance tonearest: Well --i------------------------------------_Foundation -------------------- Prop. Line ----------------_----. REPAIR/ADDITION(Prev. Sanitotian=Permit# ..______ I__.___---------------------------------- Date ____-________________ Septic Tank (Specify Requirements) ---------------------!------------------.-------------------- Disposal Field (Specify Requirerrcents) ------ ---------------------------------------------------- C/ ---- ----- / '+ 1 (Draw existing and required addition on reverse side) ---------- I hereby certify that 1 have prepared this application and that .the work will be do 41 in accordance with San Joaquin County Ordinances, State laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents ' nature certifies the fol I wing: F certify tinClect to ante o the work for which this permit is issued, I shall not)employ any person in such manner as to bet a suo rkma mpensati.on laws of California." Signed C { �. Owner BY - ------------------------------------------------ l s -_ t Title (If other than owner) € FOR .DEPA�TMEN> USE ONLY APPLICATION ACCEPTED BY ... .= - # B ILQENG .PERMJT.ISSUED..: i ADT /E - - ---- - r �-- - ] --------------------.___DATE ____._:m = __ ....-- ITIONAL COMMENTS _______ ___ __________r_____ _____________________ ________ -•..`�..____,.1_„•-• \ 11 ___-_ _ __ _ __ - ______ ________ _ __ ------------------------------------___---_------- Final Inspectr ------------------------------Date -------- SAN JOAQVIN LOCAL HEALTH DISTRICT i E. H. 9 1-'68 Rev. 5M