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FOR OFFICE USE: �4PO4PPUCAI&'f SANITATION PERM Permit Na (Complete In Triplicato) . .............. ................................. . 7 ........................ ...... ....................... ...........W.......... This Permit Expires I Year From Date Issy Date Issued--.!•S.? :7.7.:, Application is hereby made to the Son Joaquin Local Health District for a permit to construct and Install the work herein described. This application is made in compliance with County Ordinance Isla'. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION 703 . 6, W 1 'q M 'C"0 ra f"' D rl 4 A/"r-- .............. ...... ...................................X.......... ........ ..........CENSUS TRACT .......................... Owner's Name ---_-------_---- ------_-- ...... ....... ---...Phone Address ..............X 13 L_X. i -_--------- ............ ......... ........................city --.........:........---------...---•-- ..................................... . Contractor's Name .......j.4.C_X.... # Phone i .. . 7 Installation will sery Residence 0 Apartment House 0 Commercial OTraller Couit a MAU4RV rMotel []Other............................. ..............I Number'of living units:............ Number of bedrooms ---------...Garbage Grinder ............ Lot Size .... Water Supply: Pubf ic System and name ........................................................................................................ _Private _ Character of soil to a depth of 3 feet: Sand ' Silt 0 Clay 0 Peat 0 Sandy Loam 0 Clay Loom E3 Hordpan.0 Adobe(J Fill M6terlal .......:.If 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: (No septic tank or seepage pit permitted if p1blic sewer is available within 200 feet) rV Size --------- ........... PACKAGE TREATMENT I ] SEPT15;,IANK 04 -------- .--tiqu-id Depth .........------- • capacity - Type 1 Maieilal.-�Al-.Ca704.. Compartments ___- 7............... Distance to nearest: W611 --f......Foundation .............. Prop. Line ....... Wd ; - - LEACHING LINE [h] No. of Lines ..........�4---------- Length of ooch'*'I'Ine_.:7/4).._ ............ Total Length V Box ....... Type Filter Material _ -terial 4........ _Depth Filter Ma ---- ------- Distance to nearest: Well }...t -IFoundation .......... Property Line .... ....... SEEP T Depth ...__------_---- Diameter -------_...... Number ............................ Rock Filled Yes ❑ No (31 Water Table Depth ...................................... Rock Size .........._:....... ....... Distance to nearest: Well ----- .........................Foundation .................... Prop- Line .... ................. REPAIR/ADDITION(Prev, Sanitation Permit# .......... ..................................-00tw...................... Septic Tank ISpec!fV Requirements) ...... ---_................ Disposal Field (Specify Requirements) ---------Z ........................... .........I.........I-------------............... --------------------------------------------------------------------- ................................... ..................A---t...... ..........................u ....................... .............. -------------- ---------------------------------------------------------------•----._..--•-------_...._..._.. ---- ........................... ............................. (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be done In accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local HeaI&DIstrict. Home owner or licen- sed 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 By ............... Yitle ... -�...................... ........... ................ other an owner) ZfOR DEPAJNMENT USE ONLY APPLICATION ACCEPTED BY - -- ---------------------- ...... . ------- ---------------------------------------------DATE —........................................ ;,----------------I................ DATE ---4-:7 BUILDING PERMIT ISSUED -........ --------------------------DATE COMMENTS ........... ------------------------- ............__.................................................................................................. ----------------------------------- -- -- -------------- .............. .............. ... ------ Z------------------1�--------------------------------------------- ------------------r-------------------- ----------------------- .. ---------------- ------ . .1 -1-1.......... FinalInspection by. ------••-•--•-••------•-• ............................ 7....................... ------Date ... . ............. EH 13 24 1-68 Rev. 5M SAN JO UIN LOCAL HEALTH DISTRICT 8/74 3M