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FOR OFFICE USE: APPLICATION AOR SANITATION PERMIT ON IF Permit No. : --------------- - - Complete in Triplicate} �-o �- p Date issued ---- -------------- --�0 This Permit Expires 1 Year From Date Issued �. rict for a it to Application is hereby made to compliance ecwial Hh County ealth tOrdinan a Nom549 and ex sti 9 Rulesinstall nd Regulat onsreirti; described. This application _ .- _ 7- r. CENSUS TRACT ----- _IY-- ---------- JOB ADDRESS/LOCATION .------ (3�" -----��'-- --��-`�--- -----E��----- - - aPhane " Owner's Name ----- � l+R -------}^ L -•-- Address --------- --------- '------ - �' >� City Contractor's Name ------------- ----- - License # -- -- �# !" - Phone Installation will serve: Residence ®.Apartment House❑ Commercial ❑Trailer Court ❑ , Motel ❑Other -------------- ------------ -------------- 0 ------------ .. _ Number of living units:__-------- Number of bedrooms ___�±--__Garbage Grinderi`__,__:,,___ Lot Size -------- Number __-- . 3 t ,. f r Water Supply: Public System and name .---------------------•-- - Character of soil to a depth of 3 feet: Sand'❑ Slit 171Clay ❑ Pedt❑ 5andy Loam g Clay Loam ❑ • Hardpan F] Adobe E] Fill Materiary. l.._Y---" if Yes,type _.-------------------------- 6uildings, etc. must-be placed on reverse side.) {Plot plan, showing size of lot, location of system.,in relation to wails, f. ,'; NEW INSTALLATION: (No septic tank or seepage pit permitted if.public sewer is available within 200 feet,} 'E A. Size____- --`---'--' ------------------------ L,quid Depth PACKAGE TREATMENT [ ] SEPTIC TANK [iy]� i ;; le ; - Capacity -__'_k20C�-= - Type --Pre---�`�} Materia!'_-_jlliCYe? No. Compartments --"- "-` _ ^au., E �f,� ._-� � Prop. Line - t i. Distance toZnearest: Well- ---_ :-"----- ------- -- E - �_-Foundation`-- _ ----- Total Length ------ -------------- 9 - LEACHING LINE lme_____""--- �� '� Filter', .Material __--"------- ------ No. of Lines �.- Lenth o each D' ,Box . .------ ;Type Filter Material- " rGs f r _ � ---.----- Dis}ance to nearest: Well 3--------- ----------- Founddation z� ; ------- Property Line _._ _ _ •-- Rock Filled Yes ❑ No 0 SEEPAGE PIT [ ) Depth -- Diameter ---------------- Number Water Table Depth ------------------------` Rock Size ---------------- Distance to nearest: Well -- --------------- - ------Foundation ---------------•---- Prop. Line -----------------------k I `i ! �-.----- Date a_te_--_--.-->-i----R---.-�----u--- ------------- REPAIR/ADDITION{Prev. Sanitation Permit# -----------`''--- ------1- ------ - - --------------------------- _ Septic Tank (Specify Requirements) ---."-------------- --------- ---- I Disposal Field (Specify Requirements] ____-___-- ---------""---" ""---"-- --""-- " ----------------- -` ---------------------------------- ---- -- ----------------�- - ,� {Draw existing and required addition on reVersbe s e�---""-------- "" .r n I hereby certify-that l have prepared this application and that the workwill a one in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: t "I certify that in the performance of the work-for whichfhis permit is issued, t shall not employ any person in such manner _ as to become subject to Workman's Compensation laws of California." _ wOwner Signed -- -- -- ------------ ------- - - Title, ---------- B t Y - (If other than owner) FOR DEPARTMENT IJSE ONLY n DATE -2 APPLICATION ACCEPTED BY _- �� - '_ �`�r « �' =DATE ".. BUILDING PERMIT ISSUED -------------- - �er� �L ADDITIONAL COMMENTS ><�" � --: -iii__A --�irf�[� �sL � � il��-� s �� ,, d,c ��o----- - ------!5ew % i , F RC1 9S c 'm `�- Mrd �x _ "- --- ------��------- -=-- ---------- - - 11f1. zl�GL -� Date ----13-- --- - Finai Inspection by: L---- z3-3�- �--- --- - � --�--�.-"'�- -��G`-�-�- ----------------------------- SAN ------- ------ - -- - - SAN JOAQUIN LOCAL HEALTH DISTRICT_ E. H. 9 1-'68 Rev. 5M C.GCC� 6tc- c ew