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- FOR OFFICE USE: �` _ APPLICATION'PO SANITATION PERMIT . _ , Permit No.:.-- _-- ---- (Complete in Triplicate -"- ------------------------------------- Date Issued This Permit Expires 1 Year From Date Issued I ,San.Joaquin Local Health District for a permit to construct and install the work herein Application is hereby made to the described. This application is:yriade ieompliance,with County Ordinance No. 549 and existing Rules and Regulations: 5_0 i" - CENSUS TRACT -------------- ------------ JOB ADDRESS/LOC TION - G_-3 �---�-�-� Owner's Name --- --------- �1? 11'�!I" a--------- ------------- - Phone Cv:( 1- Address f �p R=S:S =�P---------- City --•------------------------- ---------- -- cp s.p'. license #251677-7-- Phone -6�3-- --- Contractor's Name•"W�tl_#��.A.------- j •_- In pllotion will serve: Residence impartment House❑ Commercial :❑Trailer Court ;❑ ' Motel ❑Other -------------------------------------------- i ] ? � Number of living units:_�!"___- Number of bedrooms 3------Garbage Grindery,6_F5 Lot Size "-" �------------- -"""------------- Water Supply: Public System and name - -- � i N'�"__C E Sr Private ❑ Character of soil-to a depth.of 3-feet: - Sand.' --Silt .. Clay- Peat ._ Sand Loam - -CIa Loam=.T— - mm � y-❑•� ❑ Y- ❑ Y~ � +f Hardpan ❑ Adobe'❑ Fill Material __ if yes,type (Plot plan,--showing*size-of Tlot,- location-of-system"in->relation--to-wells;-buildings,etc.-must .be placed-.on reverse side.) ' NEW INSTALLATION: (No septic tank or seepage it permitted if public sewer is available within 200.feet,) ' !� Gi PACKAGE TREATMENT[ SEPTIC TANK'[ Size_" --------- e'Liquid Depth ----�� .--------,----• T� Capacityl"J�__�_Q-- .--- Type PIR-ECO-5 Material No. Compartments _._"._.___ 1 'r-__ PropLine _" � �_-_Di fiance to nearest: Well _----------- ------------Foundation . ------__- Length of each line--- """�- _ Total Length -- LEACHING LINE No. of Lines ---- 75 J 'D' Box -_ Type Filter:Material _g�oc ---"Depth, Filter Material -""_---1 ---=------- ---------------•- 1 --- Foundation //Q ----€--- Property LineA�-----4- Distance to nearest: Well _"_ "_" 1,----------- SEEPAGE PIT { j Depth Diameter ---------------- Number ----__ ----- __ Rock Filled Yes ❑ N0 .0 ------------------ - Water Table Depth r ---Rock Size ---------- --------------------': .- Distance to nearest: Well ----------------------------------------Foundation -----'-------------- Prop. Line '-------.------.---_ REPAIR/ADDITION(Prev. Sanitation Permit# -:^-------- ------------------------------- Date L----------------- - -----------1 Y *01 ;r.,.,...,�..-�-.i 1 Septic Tank (Specify Requirements) "-'------------------------------------------------------ _ Disposal Field (Specify Requirements} _�__":":""___""_"_""_._"_""_"_________"_- ; C3 f i _ t ----- ----- 1 (Draw existing and re uired addition 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 Iilltn_- sed agents signature certifies the following: "I certify that in the performanceof 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 -- - ---- - ------- ----------------- ----- -- ---------- caner B -" - - .. _ - _ . --------- Title "".." -------------- -- TRC)L1 - - - ----- ,.; , - T i iS Tip CO � other than`owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _T' - C� - -- ---------------------------------- DATE ". `� - ------------- -- ---------_----------------------------- BUI'LDING PERMIT-ISSUED""-�w ' �`.• .`r'"'"_� _...-. ------------------------------------- ADDITIONAL - -- _," ---DATE --------'"---- ADDITIONALCOMMENTS -------- - -----------------------------------------.-------------------------------------------------'--- ` ----•---------------- --------------------------------------------------- =---=------------------ --------------- ---------- i ---- - --- - ------------------------------------- Do D t - -------------- --------- ------ ------ -- ------------------- -- - - --- Final Inspe - a e r� # U SAN JOAQUIN LOCAL HEALTH DISTRICT t E. H. 9 1-'68 Rev. 5M '