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FOR OFFICE USE. ! APPLICATION FOR SANITATION PERMIT , 3 Permit No. _,76....'13 .......................................... (Complete in Triplicate). .................................................I....... 'l! p /W.!lG h /1-6' 7� /vP� �Qd Dote Issued .................... This Permit Expires i Year From Date Issued ......... ................................ i Application is hereby mode to the Son Joaquin Local Wealth District for a per to construct and install the work herein e with County Ordinance No. 549 and existing Rules and Regulations. described: This application is made in complianc JOB ADDRESS LOCATION .. 1.,J1 �....... (j ' ............CENSUS TRACT • iUwner's Name . -- --•...._-•--••. •-•-------- ,........ ..�..................... �....�..Phone Address `ms�f ............ - ------------- - -•----•-----•-• - - - ......... y r Contractors Name .... .:f'L! .�%'s r �._ . . ��`fjy- Phone �•j� . .. -•�– --..License- f • �,l– �. Installation will serve: Residence to ApartmentvHouseo Commercial ❑Trailer Court ❑ �i Motel E]Other ............................................. ti Nutnber of living units:..: ...... Number of bedrooms ..._.Garbage Grinder ............ Lot Size ............. - 4' Private Water Supply: Public System and name ---------- -------------- ` ti,; - .-- Charocter.d'f soil to a depth`of 3 feet: Sand E] Silt❑ Clay ❑ Peat r Sandy Loam Clay Loom ❑ Hardpan ❑ Adobe❑ FiII,Material .....-...... If yes,type--------------------------.- (Plot plan, showing size of lot;-kcation of system,:Jrt_relation to welds,#buildings, etc. must be placed on reverse side.) I NEW INSTALCATION• (No septic tank or seepage it ermifted if public sewer is available within 200 feet,) /1 I s p P P P PACKAGE TREATMENT,-[ I SEPTIC TANK [ ] ............. Liquid Depth .... I. .......... Capacity Type tl ti_ � citerial -------------------- No., Compartments i F . r Foundation i Distance to nearest: Well I Prop. ........... LEAtkg1NG-LINE"-" �j No. of Lines --�------;•-•- g � t � . �G-(�-/--- ------ Total length ��----•........... ..: Len th of each lire.. g - L €� t Material J/u . :Depth Filter Material ._. 7......................�. ..--- D' BoxT a Filter , f ` Distancvto nearest.�11/e1iFoundation ---- YP _ 9� PropertyLine . --......... -oma{ u. SEEPAGE P13: ( 7�:. Depth ........ Diameter a___...• ' Number ----------_~=------------ Rock Filled Yes ❑ No ❑ ' • INater iTable Depth.... "a. - . � :Rack Size -------------•-- ••-•-•---•---- _.. `. _ 3, t t Distance to neares�Well ---------- ---`.. ----------- --•---Foundation ..................... Prop. Line ............. .. . REPAIR/ADDITION(Prev::.Sonitation Permit ............_. . ==---......•-• --.. Date..:..::::.............•._.......... , P I Septic Tank (Specify Re b rements) ...�.....:....................--1-- ......-•----.•.............................. ..__..............._.. Disposal Field.•(Specify Requirements) .--_--•---.-. .....�----------- --••--...----------------------------- -a).""g •............................. - i , t" �- --------- --•---------------••-------------- (. - ........................................f.a. iC � 4 .....__._ ......._.......... --------------------- __;--••--•------..Draw existin and required addition on reverse side) . 1 hereby certify that I have prepared this I application and that the. work will be done in accordance with`San Joaquin ,F County,Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Horne owner or Been- County, sed agents signature certifies the following: _ i "I certify that in the perfor ante of the work for which this permit is issued, I shall not employ any person in such manner as to become su ject to ark 's Com ation iws of California." i Signed .--.. -- ---•� - Owner .{ a . Title *~r........................:..........._....... �------......... By ------------- - ---------------------•--------------------:----.- ...-------------------......... ,_. 4 . (if other than owner) FO DEPARTMENT USE _ONLY. . Y r =•.,_`"�_ e.:... .... ••-••........ DATE ..,,�� .�.,../.. .............. APPLICATION ACCEPTED BY ..... � BUILDING PERMIT ISSUED ADDITiCiNAL COMMENTS ......w .. _ ------ _ ......DATE......,..: --------- _....-- - -......-•-----••••------......:."...... ..................................................... . .. - :... _ .�ti. ......- � . .. ............. ... .. ...... .... ...... ...... .... ........... v.� . —..._- - r ---•- ...... f... --•--•••• Date Final Inspection by: . l r SAN JOAQUIN LOCAL HEALTH DISTRICT C ,. 11 24 7/723 ,4