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FOR OFFICE USE: FOR OFFICE USE: �i FOR SANITATION PERMIT p / / 4 --- -`' --------- ------- ------ [Com Permit No.--. 4 G' `od - APPLICATION ----------- - -�-- � (Complete in Triplicate] \�o ------ --------------- ---- r Date Issued--Q_-��f�-�- G This Permit Mkpires 1 Year From Date.Issued� __, Application is hereby made to-the San Joaquin Local Health District fora permit to construct and install the work herein_ described.) This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: j r ` - . : /+ .. CENSUS TRACT�--JOB ADDRESS/LOCATION 3 Phone = - er'sm - ------OwnCity. QIP Address ---C=0 `Zl icense Phone-. Contractor's Name_.'- i Installation will sere: Residences Apartment House.0 ,Commeraal;❑ Trailer Court El' j r4. Motel. _ I, S. 9 Y 0l. Number of living units:--A------------ --------Number..of,.be' rooms' --Garbage Grinder ,�-Lot Size -- ---._- 1�., �.- s ---------------- } i s -- Private z Water Supply: Public.System and name =: -----'-----=---- --- ` = Character of soil to a depth of 3 feet: Sand-'ElSilt El Clay El ; Peat❑ 'Sandy Loam ❑ Clay Loam❑ Hardpan ❑`Adobe W'Fill Material-.--:____.jlf yes, type-,+--------------------_-__-. - (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reveruaeyside.] NEW INSTALLATION-' JNo°septic tank .or seepage pit permitted if public sewer:isavailable within 2010 feet,) PACKAGE TREATMENT [ ]` YSEPTIC..TANK Size- --11-- -- - Q---------------------------Liquid Depth- i46---------------- I } -Capacity_ 0 yp 71 _No. Compartments-------- -------------- ------ ----- ----------- - . T e aterial Distance;to.nearest: Well.. . ---- - �� = Prop Line o ----Foundation-.-___-..- •. LEACHING LINE_ j'l. . No: oLines_. -- length of each kine.. --; Total Length] --------- ` r 'D',Box -Type Filter Material- Depth Filter Mrateri'17 _la-1'f---�' IR Disfiance.to nearest: Well_ ---- .rFbundation---- 1_ ------- Property Line-_-- _ � .� ,. � � � Fill Yes N SEEPAGE T ;[ 1 Depth--- Q.-:_---Diameter--- - _ ----------- ---- Rock ed o ❑ -- -----�'y`-�a-_-Number---;---- - t y Water Table Depth Q .. ! : Rock fSizei p , U "Foundation------- 1 ......--- Prop. Line--- t IO'DistancA to nearest: Well �__--�-_-------=--------- =- --- - � :• w _ - REPAIR/ADDITION (Prev:Sanitation Permit#---------'---- ------------- - ---.Date------------_------ ------------=---- = 1 i ' ------------------ ------------- Disposal --- ------- I Septic Tank (Specify Requirements} ----- =-�-�--- - - ----=------ ---=----- ----- ` --==--------- =---�----= Disposal Field (Specify Requirements)--------------i------- ---- -------------------------------------------------------------- ----------------------------------------- - ------------------------------------ - ----------------------------- ---------------= ------- i r ------------------- ------------- a --------------------------------- ------------------------------------ g ------------------ -- -- -----------------------------------------------" t v prepared pg a Draw existin and required addition on reverse side)' , I hereby certify that I have re ared this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws: and Rules and Regulations of the San Joaquin Local Health District. Home owner or licensed agents �... .- .T signature certifies the following: j "I certify that in the performance-of the work for which this permit is issued, .1 shall not employ any person in such manner as to become subject:to..Workman's Compensation,,laws of California." -- -- ---- -- - IVCE'S S Signed _ ,, Ctwnex -_ :- - 1GI.ARE `SEPTIC &• SEWER SERVICE = .-Title ------------ By- 263 So-:Otte SEctffn;t3tifi. S52t15 - . . (1`f other than�r)C Ph.463.3209. Contractor's Lic. #267177 " FOR DEPARTMENT USE ONLY` 7" APPLICATION ACCEPTED BY`_..--..--- i - - ----- DATE .. -- --- ------ � ---------; DIVISION OF LAND NUMBER - - -.------- -.--- ---- ------ DATE - ----------- -- --------- ADDITIONAL COMMENTS.- -.f -7I ' Q . -- ". - --------- 't_ .. o. --- c - - ---- - _ _ Final ins ection b �._ . = ate - ------------ EH 13 24 SAN JOAQUIN LOCAL HEALT iSTRICT F&s 21677,REV, 7/76 3M