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�lO OFFICE USE: w 'LICAVON FOR SANITATION: . /�� Per Na. . ' .. ..._. ....:................... 4-� (Cotnpletein Triplicate) . r } Date Issued This peVnilt Ex ices 1 Year Frof 1 Date issued 1 ......................................................... 'f for a it to herein Applicatio is hereby made o the dean tom lean eEawitfedCouDytOrdinci ce Nam549 a d exis i g Rulesinstall ndthe Regulations.. described. T is appli4 ma p CT ............ ....... JOB ADDRESS TION . --- --. .. # �r . --�` ..CENSUS TRA -.- : . ................. lone Owner's Name _ _. __..._ . .City ........... y. . S •� Address -• . .......... ...... License # Ph ne Contractor's Name # Installation will serve: Resi nce 0 Apartment H sed] Com ercial moiler Court r r,. tel [p Other_.. .... •-- ......... G ..... Lot Sire �®......... .. ...... Number of liven units:- Number f be aoms _ G rba a render ... 1i 9 - �c � -(!. ......................... Private to Water Supply: Public Syste d name ...-- -- --• - ------ •---•---• •=,, Ch ratter of soil to a depth a 3 eet: Sand Silt 0 Gay ❑ P t© Sandy Loam 0---G aY Loam r-w yes,type � �--�-�" Hardpan Adobe fl Fill Mater al ............... •........... (Piot plan, .showing size of Iot, c tion of syst m in relation to well , buildings, ,etc. must be.placed on reverse slde:}� NEW INSTALLATION: {No septic n or see a pit permitted ;if pub c ewer is available within 200 feet,) ( Q r_.... . p ': .Liquid.Depth ..._ /1 } PACKAGE TREATMENT f I SEPTIC Siz x 4 .... Capacity ..� •----- YVe �.. . �f Mater al.� ----.. .. No Compartments ..... ..Foundation ...7.P-••<-•••••• P op. Line • , Distance to ne est: ---- --A. -P7 ' tQ.._.. h ..._ -. ::........ LEACHING LINE ( J No. of Lines .._..._ ......... ength of each li e- -._-._... ._.. TotolLeng/ �Q ,Q . .. th .Filter Material f�......................... 'D' Box ____•---..._ Ty F ter Ma ria4.5�..--�/.. - .....--•- -.. i Foun tion] Property Line .....--•................ Distance to nearest: ell -_-• • --•- - •--•----- J ....--------•_......_... SEEPAGE PIT ( { Depth -_-_-.-_.- --------- D�me r --- ---:-__.- Num er ............................ Rock Filled Yes ❑ No Water Table Depth Rock Size •................... .Foundgtion •.--.--• Prop. Line ..................I....: 'Distance to nearest: Well ... ..... ....: •----_-•�••- REPAIR/ADDITION(Prev. Sanitation Permit# -- ••---••••.__ Date*.................................. Septic Tank {Specify Requirements) -------------••-••--•••••- . ....... ......_--- •--- _-- ---•---•------ Disposal Field (Specify Requirements _-------• ---------- ------ --- - --- ----- •-------... ---- -------------------•----.....------.... ..................... ...... -----•-• ---- - - ------ -- ------ ----------------------------•- •--- --- - (Draw existing and requir dditio on reverse side) I hereby certify tliat I have prepared this application and th the w rk will be done in accordance with San Joaquin ` County Ordinances, State Laws, and Rules and (Regulations of e 'Son Joaquin Local Health:DIstdct. Hanto owner or Ikon^ sed agents signature certifies the following: "I certify th in the performance of the work for which this permi, is is ued, I shall not employ any person in such manner • 'S, : ns to becom bjecLto Workrga s Compensate n laws of Californ _.-,•Signed ..--- ------------------------------ O r er ., By ---- ----. _ ----------- -•--•----------------- Title ...................... a (If other than owner) FOR E�ARTMENT USE O Y APPLICATION ACCEPTED DATE LL " - ---- --------- BUILDING PERMIT ISSUED ----..._ -------------------- - ADDITIONAL COMMENTS ------- ---• `..' ---------- - ------------ -- - = - �''� f - •--= Date ....._... ---------------- ------------------------------------_rV. 15;M _.._____ Final Inspection by: ----EH 13 24 1-68 SAN JOAQU LOCAL HEALTH DISTRICT $�7�1 3M r z