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APPLICATION FOit a _ FOR OFFICE USE: SANITATION PERMIT -- ----------------- - -------- / - --- Permit No. 3- (Complete in Triplicate) r ----------- Date Issued -5-11 3/ 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 andel existing Ruled and Regulations: J013 ADDRE 5%LO T5;d - �h �5 �f- --4C NSU u R f Z �Z ENSUS TRACT v. --------------•----------- Owner's Name -- l `G_I L Phone Address ------- �5"� ------- Phone� ---------------------- -E] ----�/ Contractor's Name ----------�,�------ --��--------------------------------License �. -;----� Installation will serve: Residence partment House Commercial :❑Trailer Court Motel ❑Other -- ------------------------------------------ Number of living units:--------/_ Number of be ms ___a---___Garbage Grinder Lot Size `•---- ' Water Supply: Public System and name -------- 'x w �-- -- -----��F�-- ------------------- -Private ❑ Charac e"r of soil io a dep h of"3'fe '"'Sa`nd"0-r-SiIt_O °"Clay` " Pe'at❑"`"Sandy Loam❑'�Cfay�oam"❑J"^ i , Hardpan ❑ Adobe Fill Material---- If yes,type ____________________________ 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 available within 200 feet,) i PACKAGE TREATMENT [ SEPTIC TANK [ Size� --- f��- -------------- ----- Liquid Depth ---- -- Capacit 11 1�tT_e Material_ No. Compartments ------------•-•------- f Type Y Foundation= �f __. Prop. Line ._n-_---.—______.. Distance-torneares#:-Well- - _= -=`==_---- - " LEACHING LINE [ No. of Lines 2,__-.2--------- Length of each line___ ]- ----:Total Length - __________________ r ;. , t r 'D' Box -- Type Filter Material - 44-------Depth Filter Material ...rI.-_-_____--_-________---____--•__._ - Property Line .:._ Distance o nearest: Well ...... _ Foundation _. ___d.___- -__._ __ p ty --------------- S "A'"`P' -- Rock`Filled' YesCl PIT I l �eptfl "Q: ' "Dian)-ete�� - - Number" � Water Table Depth j -------------------•Rock Size ---112 X-----------------Ir i Distance to nearest: Well ---____- _ -----------------• Foundation /a---------- Prop. Line --- ------------------- REPAIR/ADDITION(Prev. Sanitation Permit ------------------------------- --- Date _________-__________--_-----------) 1 Septic Tank (Specify ReS uirements) --------- ------ ----------------------------------------------------------•---------------------------- ----•- DisposalField (Specify; 'Requirements) ------------------------------------------------------------------------------------------------------------------------------------- �-- .f - --__ 1._._ .-=-- ------------------------------ - ----------------------------------------- ------------------------ ----------------------------------------------------------- ------------- ------------------ ------'---------------------------------------------------=—=___--�-�------------------------= - (Draw existizng and_requirred addition on reverse side) rl 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 licen. sed agents signatureaertifies.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 - - wne B — Title _- _ � -------------------------- (If oth th owner) FOR DEPARTMENT USE. ONLY APPLICATION ACCEPTED BY --- } --- DATE �- .7� :3 BUILDING PERMIT ISSUED ._.'---------------- ---------------- -- -----------------------•------ -------DATE ------------- ----------------------------- ------------------ - -- ADDITIONALCOMMENTS ---------=------ ------------- ----------------------------------------------------------------------------- ---------------------- -------------------------------------------------------------------------------- ---------------- - -------------- ------------------- = = '----------- ---- ---- - Final Inspection by ' -------- ------ -- - - - Qate - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1"btu Rev. 51V1