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FOR OFFICE USE: ..,} APPLICATION FOtt SANITATION PERMIT .................... .._ -- ..7 :. ... (Complete in Triplicate) Permit No. This Permit Expires 1 Year From Date Issued Date Issued - ._. '.�f..- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein t described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .,/..�'G_��?_�.��,�'�"�"� .'.._.- �""." ,-�........ �`�F ..CENSUS TRACT Owner s. Name .. .:.... .. ....:..t�l.._ ._. ---------... .............. .,Phone . �CJ Y5• City S- T...:..... - -. Add Contractor's Name-- ._:: .. s47 �'1��.- :.•- :... - License # :...:.. Phone Installation will serve: Residence partment•House�E] Commercial-[]Trailer Court .a t d . Motel r7. Other .. . ! ,Z J �-Q 4 �' i r Number of living Vn�ts:.:.:......... Number of.bedrooms....:,., ._,_Garbo e.Grine#er'..-.-- -. Lot:Size _.... r .-_-•----.-.,...._... .. g 9 •" . E r Water Supply: Public System and name ... ... ... ..... _ L private Character of soil to a depth of 3 feet: Sand [3 Silt El Clay ❑ Peat 0 Saridy Loam .Clay Loam n A- Hardpan.[],,� Adcabe-g,.Fill-Materiol—.. _' __:..I{ . .(Plot can,, slawin ----=---- -- � � , p, g .size of-.lot,.location of.system..�n:. relation to "Wells,. etc:..must .be. placed on-; -ANEW,INSTALLATION• ' {No septic tg6k or seepage pit permitted if public sewer is.available w,,thin 200-feet,} -• - . PIACaGE TREATMENT ] ] SEPTIC TANK_ Size y�a....r " ..:......, . Liquid Depth ...- ,...� ; . . ..:. ; 67 Copa6ty Type Material No. Compartments: ._ ' Distance to nearest: Well 3 ��.d .... .... ......:....Foundation Prop. Line /S 0. / LEACHING LINE No. of Lines Length of each Zine G�_,...._.:.. ToTal length i� _ 9 l { " "D' Box ...'Type':Filte'r'�Materiol '._ l5epll Filter Matenol i Distance to nearest: Well :.3 . �_...__.: ::"Foundation Property Line .............. .. SEEIsA1GE.PIT [• ]: Depth :-:: :: Diame#er: Number Rock•-Filled --Yes No. � i Water,:.Takile. Depth -- _ -. �._ .._ ._ Rock-Size . . :_ o Distance to nearest: Well." ..Foundation , -, Prop Line_--: ., REPAIR/ADDITION(Prev. Sanitation Permit�# ..__._... Date : __ _ l .. p I i Septic Tank ISpecify Requirements) _ :^ . "" , i Dis'posa! Field (Specify Requirements) -= --- --------- _.. .-_ . -•..... ........ ......... .......... .. •---- ......°.... :_. ........... . -- • • . •--• (Draw existing and required,addition on reverse sidel.. I hereby certify that I have prepared this application and'thai the work will ;be done in accordance with San Joaquin Cooniy Ordinarices, State :Laws; and Rules and lteguiations of :ti►e San Joaquin-Local health Diitrict: Nome owner or licet- ;} sed agents signature.certifie s.the following:: .' • - .. ,,, Compensation e . . P i shall not ern , y y:P ; . _ ... i I certify that in the performance of the work for which this permit is tssued plo an arson in such mann as to become 'subject to Workman s laws of California. --•------------ ----------- -T !' BY .... ;_. .......... •Title V1 ......... .. ��.�! . . .. . , (If other than owner), 4 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ........................... ..........i.. . _.. . ....... DATE . 5 l.. ..... ... BUILDING, PERMIT ISSUED:. .......... _........ ........ ::..DATE,..._'....:_::.. :.`_ ADDITIONAL COMMENTS -• �- :--------- ------- n._ _. . ....... ......... . ................... ......... ........ -------------- Final Inspection by: .......... -- - ----------- ---------------...........-- ....Date --------- LA,N ,JQAQUIN LOCAL HEALTH �RIC7 <.... ....- -..w...s.M1....rsr-...� ti-+.4•-- _ +wr+ef.�., E F i 13 24 1_'AQ De,. '-KAA. 7/723 ,11 i