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FOR OFFICE USE: APPLICA 11'3-"'_"MOR SANITATION PERMIT -------------- ------------- I ___---__4:------------- ------------- - �= ICompletein Triplicate) - Permit.No:,_'_/=3G� ---------------=------------- 1 `' ! Date Issued --4 --,2-a-71 -,- ----_- This Permit Expires 1 Year From Date Issued Application is hireby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. Thi's application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: r JOB ADDRESS/LOCA ON ._/ -' _/ Q � J¢ ------------- -CENSUS TRACT T ------------ i _ - /0_ e- 1 , feOwner's Name _ f - --------------------------------------------- -------------------PhonAddress ----- - � ' _ ------------------ city Contractor's Name --- Tc `�C. --------------License � -�OPhone d- - i Installation will serve: Residence r,partment House,[] Commercial:E]Trailer Court Motel ❑-- -. Other-__-----_ - - ---------------------------- ---- Number of living units:- ___-- Number of bedrooms ----Garbage Grinder '-__ Lot Size �®__ `X �-10 f Water Supply: Public System and name ----------------- -- ## Character of soil to a depth of 3 feet: Sandilrfl Clay El Pat[I Sandy Loam Gay loam:[] r H'ardpon g Adobe E3 Fill Material-.--�- i if yes, type ------------------- - Pfot plan, showirl a of lot) location of e r � ,. f rr• -�. q � � ;{� p � g- � ��. �" .� system in relation to wells, buildings, eFc. must be laced on reverse'<side.► � '�--- NFW INSTILLATION: }� I p (� (No se'p'tic tank or seeps a pit permitted if public sewpr is al a I within 200 feet,} PACKAGE TRPA-,MENT [ ] SEPTIC TANK � �� { 9� r��'Yf: �� r1--� �. � °�f -x ��// Size.. -= - Li9uld1be"th -Z"-- - ` Capacity'la-QQ-_ W p z +� I `h, ! �T P.e<-- //_ Material /✓ Na- ompari" nts Q i Distance 1t;." nearest:�Well f�-p_---- __ ___ ' ; ' Foundation '1( ----------- E : i 4 � Prop. Line.--•--- /- t', LEACHING LINE [ No. of Lines ! ' ------ ;- ----- Length of, each We---- ac ---------------- Total Length _cP?/Q --••-----.------ t r Type Filter Material I = �� -- --Depth Filter Material --•---------------------- --- f !Y ' Distance ,to nearest: Well'--16.0_1 � w ' 0----------------- Property Line ' € SEEPAGE PIT [ ] Depth !- ---------------- D;ia eter - �' -------- ------- Number ---------------------------- Rock Filled Yes � N � i} Water'Ta'ble Depth 4 F 1 f =------------------- ---------------m-__Rock Size ' = f i Distance to nearest: Weals I-------- ' Foundation ----------------------•------ --------------- ---- Prop. Line --------------.... 1 REPAIR/ADDlr(dN(Prev, Sanitation Permit# _- i _-____ `j --------------- '' Date } + Septic Tank i(blpecify Requireme is -----i- ---------I---- ; I" Disposal Fafr{Specify Requirements} I i ( - - --------------- ( y ----------- ------------------- ' 'i i ' g , } --------------------- I E/ orf ..£.' -----------------`-------------- - ------ --------------------- r--- d �t ------- #° € .. (Draw exisin and required ddition 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 San Joaquin Local Health District. Home owner or iicen- sed agents signature certifies the following: t "1 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 --- 5 ------- ----- - ----------------------------------------- _ Owner I other t ------- �, s i e FOR DEPARTMENT USEi ONLY �LL APPLICATION ACCEPTED 8Y__-_� 9 =-------------------------- ------------ -------- BUILDING PERMIT ISSUED ---- ---- DATE ADDITIONAL COMMENT -�/_ 2�7j ,�' JOAD T E, . ------------------- 71 i '- • - -------------------------------------------- ------ I f. - -•Final Inspection by, �, -------- ------------ ---------------- -------- �7 - -----------------------------------------------------------Date --.. „ -------- --- SAN JOAQUIN LOCAL HEALTH DISTRICT _ - E. H. 9Rev.