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rti.JR VVILt u5E APPLICATIOK. SANITATION PERMIT I_..••--- 4Complete in Tripficate) Permit No. . ..........� _ _ -- ................. This permit Expires 1 Year From.Date Issued Date Issued .3..3.._7?.. Application is hereby made to the San Joaquin local Health District for a permit to construct an .described. This application is made In compliance with County Ordinance No. 544 and existing RulestalndtRegulationsfe{n 3 S'o6 � JOB ADDRESS/LOCATION .....1................•._••..-•Se....(J!✓lfllll......��.C�....,. ...........................CENSUS TRACT Owner's Name ✓/'f1 _...............:......... ....._. ._ _fid. ' ...... ....... .�/...t ............................... ._........Phone ,2 C-5"•Z Address ..........:..�l �d ...so U..IO¢/ /fid ................ �--------•-------•--...-------••---......,..._.... City .d:�lY ec,ra L ................................. ... .... Contractor's Name ----- ~'.. �!T/1 !. __ 's` SOIr--•----•-••- •-•--- ...License # 166- Phone . �_ ... Installation will serve: Residence)&Apartment House 0 Commercial❑Trailer Court 0 i I Motel j]Other-------•------------- - - - --------------- Number of living units:-_,I____ Number of bedrooms ._3--__.Garbage Grinder ____.____--_ Lot Size ..._ itc/� Water Supply. Public System and name ..>_---•._._, PP Y Y private Character of soil to a depth of 3 feet: Sand Silt Cla ............................... -.-------•--------- • Clay .C] Peat❑ , Sandy Loasm ❑. Clay Loam o , Hardpan© Adobe 0 Fill Mcterial yes,type {Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: INo septic tank or seepage pit permitted if public sewer is available within 200 feet,) � PACKAGE TREATMENT I ] SEPTIC TANK[ ] Size..... _.`............ '� fr t31 � -----.Liquid Depth y.......---.• -- Capacity 160d p Type�YP CAsY Material_.iqo !r.--_--- No. Compartments .. , _ Distance to nearest: Well •-._:.fdd .....Foundation 1R `fa_: P _.:... 6 Pro Line .� LEACHING LINE [ ] No. of Lines -----3---------------- Length of each line....... ' ..............: Total length jg-{b................ 'D' Box ....1------ Type Filter Material !3__-•--Depth Filter Material _A6 "...._ ._ Distance to nearest: Well __..f.d d.�_.._..._ Foundation ...X.5 PIT Property Line 5" s SEEPAGE [ 1 Depth Diameter ................ Number ....._.._._...._............ Rock Filled Yes ❑ No (3G, h Water Table Depth .__.._. ....___.Rock Size ......................... Distance to nearest: Well ........----------------------------------Foundation ---.................. Prop. Line .. :...:...: REPAIR/ADDITION(Prov. Sanitation Permit# .......................... . . ------ ----- Date --•---•............. � z Septic Tank (Specify Requirements) . -•••---- isposal Field (Specify Requirements) ---------_. _ •------------------------------ ----------- ----•----.........---•--•-• --------..... (Draw.existing and required addition on reverse side) t hereby certify that 1 have prepared this application and that the work will be done In accordance with Son Joaquin ; County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Norse owner or licen- aed agents signature certifies the following: "I certify that in the performance of,the work for which this permit is issued, I shall .not employ any person In such manner as to become subject to Workman's Compensation laws of California."-- Signed -.• ........ ................ -- Owner (If other er) s - - ----- OR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ..l�� _- BUILDING PERMIT iSSUEDy ••-------- -------------------------------- - ----••--------------------- ------------- - DATE..• :., __.77 = i ADDITIONAL COMMENTS ................�--- DATi~ ..........._................... ....___.:... T� --------••-•.................... i ...... ------ ----•--•- ------- Fina! Inspection by: ??_ ------ .Dates ^•fin `. ER 13 2L 1-6�3 Rev. r .. -----•----• SAN JOAQ N LOCAL HEALTH DISTRICT 8/7h 314