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' FOR OFFICE USE: �6h3 ------------ MICAON._j=QR SANITATION PERMIT -,-"�� C lete in Triplicate) Permit No. - Date Issued � iRr(it Expires 1 Year From Date Issued y _ Ap7PI catlon'"i.ereby made to t e Stn _Joaqu.iri Local HealthZistrict for a permit to construct and install the work herein _describes. T�iis ap'pFication, de in.eampliance with Countyrdinance N 549 arm; sg Rules and Regulations: t Y .,;. .0 s..� - .. ��- 10B ADDRESSfLOCATION �_. � _ -- - CENSUS TRACT .......................... Owner's Name - Phonet�! i --- ---- ---- -- -a� ...... -------- ---------------� -- .y-- - �-�----;_: -- . -�- . --- --- ------ -- ----- -/ t --. city ----------------------- A Address --. F � J'w Contractor's Name -- ----- - � �-----------------License # ------------------------ Phone '74.b_.." �! F6`0 . Installation will serve: 'Residence ❑Apartment House❑ Commercial Troiler Court Motel ❑ Other .Cn �t-�:_._~1t; - --- - - � s Number of living units:---- Number of bedrooms __`L___.Garba e Grinder f(/_A- --- Lot Size &�-x-�7-�-T--'S------------ ------ N. Water Supply: Public System and name --------------- -- ------ Private El Character of soil to a depth of 3 feet; Sand ❑ Silt(] Clay ❑ Peat ❑ Sandy Loam ,❑ Clay Loam Hardpan Adobe;K Fill Material _________�_.If yes, t (Plot plan, showing size of lot, location of system in relation to wells, buildings,-,etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public•sewer is vailable•within 240 feet,) PACKAGE TREATMENT { ] SEPTIC TANK Size-____- !__________________ Liquid _ _ Depth ------ -------------- Capacity -_ ��_______. CapacitylXdTJP Type No. Compartments _.__ ..._..__.. 7�1 Distance to nearest: Well ------------------------------------Foundation __________ Prop. Line , LEACHING LINE [ ] No. of Lines -----�_------------- Length of each line-------74------------- Total Length ___ -�.__________ 'D' Box ----� Type Filter Material _ _ ____Depth Filte-rfMaterial ----11___........_____.__. ......r<_._ Distance to nearest:-Well- —_- =___4 -Foundation ___l �_'__._______ Property Line ___ 7_________ SEEPAGE PIT Depth -S Diameter _ - ________ Number _..___._ ------------------ Rock Filled Yes X No 0 Water Table Depth -------------- ------;-- --------------Rock Size Distance to nearest: Well ------------------------------------------Foundation if`—----------- Prop. Line _--157_-._ REPAIR/ADDITION(Prev. Sanitation Permit# ______________ _ __ __________________ Date __.________.___.__________________) SepticTank (Specify Requirements) ------------ -- ----- ----------�---- ----- ------------- ------------------ -------------------------------------------------------- Disposal Field (Specify Requirements) __ !- ,,Qcp!_ _ _ �_. .oP_ ----------------- ------------- d� - --+ - ------------1402- --- - '�`---`------ ---------------- of Gs.li..c:..litp�.�, (brave existing and requir addition on reverse sift) *1ereb;c;ertify that I have prepared this application'and,thtit-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 licen- sed agents signature certifies the Following: "I 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 --- ----- ------- ---------- --------- =-=----------=_ -Owner-- BY ------ ---- ---- ---- - ------------------------------ (if other t owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY DATE _f �-'l" ___lp ----- ------------------------------- ____ ,+rs -- ----------------- --- BUILDING PERMIT ISSUED ---------- ---------- _ -_ DATE -------------•------------------------ ADDITIONAL COMMENTS __ro�r-� L ' u-cd�d� ----- �� ------------- -- ------------------ �o sSf�6d d'C- -�.=- - - � � ----- ----------------------------- ---------------- ------------------------ti - --------------------------- ----fags=, r. T i ..r _�, -,c --------- -------------------------------------------- p --------------- ---------------------------------- ------- -------------------------------- --- --- Final Inspection by: ----------------- -- --------------------------------- ------ ---------------------.Date __.j_Lfr_-/-d -�� ---- - SAN JOAQUINLOCAL HEALTH DISTRICT' E. H. 9 1-'68 Rev. 5M