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FOR OFFICE USE: FOS SANITATION PERMIT /_�17`� �• w Permit No: - --- ------ --------- --------- """�-" J -------- ,Complete,in,T'riplicate 7 r 1 ------ Date Issued - 1 � d This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: ------------------------ JOB ADDRESSAOCATION -"-------"CENSUS TRACTl Owner's Name ._ / ------------------Phone ------------------------------------ f -- Cl% - ------- - � e� Address �p l ..� - --------------------------- City _set License Installation #� f� _.__ Phone Contractor's Name -- '-��---- ---f?Ol'�-C"---------------------------- - - - Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court ❑ Motel ❑Other -- -----}----------------------------------- s 1 Number of living units:.__/____ Number of bedrooms �"-.----Garbage Grinder /� Lot Size 949P 1C_-95i�99!9 -----•------ Water Supply: Public System and name ---•--------- ----------- ----------------- ----------------------- ------------ ----------- -- -- Private Character of soil to a depth of 3 feet: Sand'F] Silt L7 Clay El Peat El Sandy Loam [] Clay Loam------------------- oam Hardpan 10 Adobe❑ Fill Material ------------ if yes,type ---------------------------- Plot plan, showing I r size of lot, location of system in relation to wells, buildings, etc. must be placed on reversd' side.) g. NEW INSTALLATION: (No septic tank or seepage pit permitted if 'public sewer is available within 200 feet,) PACKAGE TREATMENT [ SEPTIC TANK.j ] Size ----------------------- Liquid Depth -' -------------.-.__. Capacity/ TYPee�' Material_ - '---- No. Compartments ...................... I ---- Pro Line Distance to nearest: Well ___�'"G'_""""-----------=-----Foundation __��--"""--- p• -- p: 6 LEACHING LINE [ ] No. of Lines _____�________---_ Length of each line-----g�"�.---- - -- Total Length 1�.. """-"--" Type Filter Material/� e--Depth Filter Material��----------------------- --- 7 Distance to nearest:.Well 10 .............. Foundation __:/. ------------ Property Line. _ __- ____ Diameter � - Number _ -_ — - --- -- Rock Filled yess� No I❑ SEEPAGE PIT [ Depth _ `� eo ..,.r..,,,, 14Wa.te'r- ble De th _ � y ------ - Rock Size/_-_-s`--------•---. ' . Distance to nearest: Well ______ ___��----�--------- -------Foundation a ,�-------- Prop. Line . f�� . ---- Dater `�' -------------------------1 1n I REPAIR/ADDITION(Prev. Sanitation Permit# -------- -------------------- ----- R, '�'�F Jff""�. d'�`p .. --------------- ----- --- --------------------------• A _- = Se Pic Tank (S ecif "Ry uirgrents): �+�•*,.."_: A �� x= ------------ �. p � P Y qp Dis osal. Field (Specif Requirements)k t --- ------------------------=------------------------- ----- ---------------------- ' \ -- - - t It - -- ,: ---- -- (Draw existing and required'addition on r- erse side) I hereby certify thattl havepreparecl[Nhis application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and 'Rules and Regulations ofthe San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: *�"! "1 certify that in the±performance of toe work for whr this permit is issued, I shall not employ any person in such manner as to become subject to Workman's C mpen anon laws of California." Signed ----------- --------- ---- ------ ---- --- ------------------------ Owner (If other n owner) - --- FOR DEPART ENT USE ONLY r. APPLICATION ACCEPTy � ` ? - ED BY - ----- -- - -------------------------------------------------- DATE -- -- -- r BUILDING PERMIT ISSUED ------ ------------/ ---- -----------------------------------------------------DATE ---------------- --------------------- ADDITIONAL COMMENTS ---- -- x. _ - � _ _ �-------------- ------ ----- ------------ ------- ' ------------------------------------------------------------------------------ y' . - -------------------- ------------------------------------------- -- ---- --- Final Inspection by: Dae ._ SAN OAQUIN LOCAL HEALTH DISTRICT E. H. 9 1�-'68_.Rev. 5M , ,