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FOR OFFICE USE: APPLICATION )R SANITATION PERMIT r- =o-----[--��/ ------ !' " J Permit No. -6------------ 1 (Cote:,;�iplicate] � :fir This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit 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 ADDRESS/LOCATION --------- 2_7.5--_S..__Oro-,-_-Stock on-------------- ------CENSUS TRACT -------------- ------ Owner's Name ----------------------------jL --t--- JUP---------------------------------------------- --------------------------- Phone --463_73Q67------------- Address 463_-3067------:----- Address _ 30 S. Q.�a C .------------------------ CitY19 � r9 Contractor's Name ------------ ------ ---------------------------- ---------z--------License # ------------------------ Phone ------------------ -------- Installation will serve: Residence ❑ Apartment House-E] Commercial ❑Trailer Court ,❑ Mote! ❑ Other -----TrIP_1eX-------------- ' Number of living units:......3:___ Number of bedrooms _1__e&.Garbage Grinder _none. Lot Size __________________________________-:--____. Water Supply: Public System and name -----------------Calif s___Water__Service---Ca------------------------------.-Private ❑ I Character of soil to a depth of 3 feet: Sand'❑ Silt 0• Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam,E] _.__.. Hardpan ❑ Adobe ❑ Fill Material ------------ If yes, type ---------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, .etc. must be placed on reverse side.) i NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) V PACKAGE TREATMENT [ ] SEPTIC TANK![ ] Size------------------------------------------------ Liquid Depth -------------------------- fir' f' r"t/�'`4' Capacity Type -------------------- Material------------ No. Compartments -----------------._--- Distan'te to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line ---------._--:-------- LEACHING LINE [ ] No. of Lines ---------/-__________ Length of each line.-------- Tota! Length ____��l,________-__ 'D' Box ------------ Type Filter Material Depth Filter Material ---- ___r__.______../____--_-___ j �U -------- Foundation 1p --------- Property Line - Distance to nearest: Well � _ _ _ Pro - --- - SEEPAGE PIT [ ] Depth ____p1tS _`_..__ Diameter Number ________, --------- Rock Filled Yes ° No 0 02- f� N-- Water Table Depth --------- �d-----�'------------------• ------Rock Size ------- - - ---------------- Distance to nearest: Well ------- _.-_________________________Foundation __/°__ ______ Prop. Line ......___,------------ REPAIR/ADDITION(Prev. Sanitation Permit 3,52V------ DatesA��'__�9yi`�° � -� r y Septic Tank (Specify RequireQ}.ents) --------- - 7 --------------------------- TO---------------- ------------ Field (Srecify -�Requi ments) -- -----+-- �` ='' ------- --------------- -----------='- ----------------------------------------------------------------------=------------------------ - ----- ------------------------------------------------------------------------------------------------------------------------------------------------ (Draw existing and required addition on reverse-side) i 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 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 tob o e subject Workman's Compensation laws of California." Signer------------ --- -- -- _ (-r- ------, Owner BY _---------------------- = - Title ---- ------------------- ------------ (If other than owner) FOR DEPARTMENT USE ONLY ca° APPLICATION ACCEPTED BY ------el--e----------------------- ----------------------------------------------------------- DATE _._ y; - BUILDING PERMIT ISSUED ------------------------- ---------------------------------------------------------- -----=-------- -----DATE ----- -------- -- -------------------- ADDITIONALCOMMENTS ---------------------------------------------------------------------------------------------------------------------------------- -•---------------- ------------------------------ -- _ _ --- q ----- ------- ---- �---- - . - r .�" ��'c„ Final Inspection by / � �_ Dae SAN JOAQU NN L�HEALTH DISTRICT :E. H. 9 1-'6B Rev. 5M