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r'`FOR OFFICE USE: APPLICATION s W NI,TATION PERMIT r Permit o. .� issue r .. �d--_-�1--v--- 1�- "�"�"`�' (Complete in Triplicate) d This Date Permit Expires l Year From Date Issued `s p --------------------- { ermit to construct and install.the work herein Application is he made to the San Joaquin Local Health District; or a p ibed. This dpplication is made in compliance wit ounty Ord?nance No. 549 and existing Rules and Regulations:- descx ------ Ir ENSUS TRACT =- V----- -- - .r-0-mac G JOB ADDRESS/LCATION -- _Phone ----- - Owner s Name +------ -- {: C' _ --------------- --r . Y Y- --------- --- hone-- LiceI Ct Address nse # ---.• ------------------- Contractor's -- - - -- - - ------ Trailer Court l� 5 Installation will serve-. Residence artment Nouse❑ Commercial :Q � J t Motel ❑Other _._''] "'C --GQ—bage# r - ' •E�� Lot Size --r�---�---��--------• ... �.r Grinder --- ---- -- . , Number of livin units:._-."_-- -=- umber of ted s -- 11 private [D _.___6___ .._.____ __ __-- I S Water Supply: Public System and-name -t: ti----•---------- Clay'Loam Q ; Character of soil to a depth of 3 feet: Said'❑ Silt ❑ ❑ Peat❑ Sandy Loam ,❑ E Hardpan ❑ Adobe' ;Fill Mateial ------------ If Yes, type ---------- .. , W laced on reverse side.) Plot Ian,:showing size;.of�lot, location of system in elation to' wells, build'+ngs, etc. must be p � ( P •Y NEW INSTALLATION: No septic tank or seepage pit permitted if public sewer is available within 200 feet,)1. O SEPTIC TANK'[ I Size----------- ----------------------------------- Liquid Depth -------------------------- PACKAGE TREATMENT4-( 7 W. No. Compartments _---------------=---- T . 'e. --------- Prop.Material--------------------- P s CapacitY .,_ YP Pro Line Distance to nearest: Well __--- -._Foundation -------------- - P �-- LEACHING LINE [ ] No. of Lines ------- ---- Length of each line--------------------- ------ Total Length ------------ _De th Filter Material --------- ------------ -----------•----•---- P 'Q' box .--_------._`_TYPe Filter Material -------------------- Distance -------------- - - . R - �. Property Line. ----------•............... Foundation ----------------------- Distance to nearest: Well ------'�'---- No,FO ---- Number ---------------------------- Rock Filled Yes SEEP [ } Depth ----------------_--- Diameter _----- ----- . . � '-- -----------Rock Size -------------------------------- Water --- -- --- --- - - --- - s Water Table Depth ------------------------------------ Foundation Prop. Line ---------------- es --------------- � `Distance to nearest: We ------ ------------- --------------- ' ------ Date ----------------------------------I REPAIRf ADDITION(Prev. Sanitation Permit# - --- F -------------------------- Septic Tank {Specify Requirements► }-=:'--f--- ... __ --------- -.�. - • , Disposal Field {Specify Requirements) _ �' . ' _ ------------------- ---- ---------- . -------- ----------------- -- re'. s ,r. ' - { ----- ------ ! �--•- • (Draw existing and quired_addition on reverse side) I hereby certify that I have prepared this application and thatythe work will be done in accordance with San Jaagtrin County Ordir4ances, Statetlaws, and Rules and Regulations of the San ,Joaquin Local Health District.'Home owner or licen- sed agents signature cerdies the following: "arson in such manner "I certify that in the performance of.the work for which this.permit is issued,.► shall not employ any p as to become subject to Workman's Co nsation laws of California." Owner ; Signed ---------- ---- ------------------ --- ----- Title ' s i t Y other than caner o FOR DEPARTMENT USE ONLY; ' ----.. DATE ----- - -� ----•---- �-- ----------------------------- --------------- DATE _.. = L.---,--------------------- APPL1CATlON ACCEPTED BY _.. ----� � _ _ BUILDING PERMIT ISSUED ---- -- - :--: ------------- - ------ ----- ---- -- ------------------------------------------ ADDITIONAL COMMENTS -_.- -------- ---� ------------- - ------------------------------------ -----^--- - - ---- ----------- - ------ _ ------ g-1 -� � '� -------- ------- ----------------------- - - -- - -------------Dat - ----- ----.- - Final Inspection b -------- SA� OA N LOCAL HEALTH' DISTRICT E. H. 9 1-'68 Rev. 5