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FQR,OF,,510E USE: -� APPLICATION FOR SANITATION PERMIT --------------------------------------------------------- # X.- �' Permit No, 4 - + . oinolete in Triplicate) I i Date Issued _�._.ss�_�__=�9` --------------------------------------------------------- This Per rit jcpires 1"Year From Date Issued Application is hereby made to the San.Joaquin Local'Health Distr "fora permit to construct and install the work herein described. This application is made in compliance with County Ordinanc!eNoe'49 and existing Rules and Regulations: JOB ADDRESS/LOCATION ------- IG �� .-------��_6_LF C---------a V_ CENSUS TRACT --C/-� '---- ----------- Owner's Name ------- -� -/Vr<-i;�-E 4�. ----------_XfO......... -------- -------Phone ---- ----- ACI._F/-C.--------�-VF------------_. City ----MAN-TF-1109---_----------------------------- Address __._.____4716-S F Contractor's Name -----0WlNF-_ -----------------------------------------------------License # ne _99--a-'74Q7: Installation will serve: Residence ❑ Apartment Commercial -. r�ajler Court'i�F� I_ — - -- Motel E]Other _. '_+30SI nL�_5-_.___QFF�t ei= . Number of linin uh'its`_ft'-y_____'Numberof' ecl or oms - ' __*Garbag "Grinde ___ _ - L-ot-Size-- __. r—�-__ A'c _ _fG, i Water Supply: Public System andname ---------- " •-------------------- ----- ---- - - ----- -------- �rivate I Character o.soil I to a depth of 3 feet: Sand'^_ . YSilt I ClayPeace Sonbl Loames Clay oam E]Har pan ❑ AdoE6 ❑ F�11 Material 'A/_0 ffyes, type ----------—---- __ F ! �.s � 1 F (Plot plan, showing size of lot, location of system in-relation to wells;i' ildings,. etc.__-must-be- pl'ced on reverse side.] ' NEW INSTALLATION: (No septic tank o 'se��d` if pm' ed-if pub9c e er rs available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK: - ,�� .Size__-_ ------------- Liquid Depth ]__31 �—_._.__. \: Capacity _gQQ-__-- --- Ty�;ARF--- Mahal--- -� -- No. Compartments ------ '-__-_-• Distoricatb-nedres well __ �� _�°-----__F hon' _1 __' -_______ Prop. Line --5-1-__ �'________ LEACHING LINE [�No. of Line ____./_--__ Length of each line____��_f __�--�----�-�Total-Length .i __��__�______-__ 'D' Box _ �_._ Type Filter Material Q_G_ ___Depth Filter Material _---- 11-9---J-.------j--------------- Distance to nearest: Well _ _____' `__ Foundation _fQ__r_+_______ Property Line. ____"'+___ (" Number' __________-_ Rack Filled es '❑ No SEEPAGE PIT [ ] Depth ____________________ Diameter _-__---____- __ __ _..____ ❑ Water Table Depth ---- ± 1---------------------------------Rock Size --------- Distance to nearest: Well -�"'i'"`"_____________________________Foundation _..___.________ p. Line ...................... IF �v i REPAIR/ADDITION[Prev. Sanitation Permit# ---------�-------------------------------- Date ________________________________I Septic Tank (Specify Requirements) ----- ---- ---- ----------------------------------------------------[----�`.�:�_. A--------------- -- ..... Disposal Field (Specify Requirements) ---------------------------- -------- ------------------------ - ----------------------- ------------- - - ------------------------------------- ---- --------------- ---- ----------�j-------------------------!------------------------ .. �.__.._ . -- -------------------------------------------------- 7y (Draw existing a�d required addition on reverse side) . �... I hereby certify thatyl-have prepared this,application and that the work will be done,, n'-accordance with San Joaquin County Ordinances, State Laws, and'Rules and Regtulahons of the. San Joaquin Local Hen! District. Home 'owner or licen- sed agents signature certifies the following: "I certify th ini he rformance sof the work for which this permit is issued shall of employ;any person in such manner as to c esu C. to rkman's Compensation laws of California." Si - -- ----------------------- Owner BY -------- ------ T�itfe -------- ---------- --------------------------y J ----------------------- (if other than owner) l s } FORi DEPARTMEblT USE ONLY BUILDING PERMIT ISSUED ------------------------------------ 51---------- - -------------------------------------------------DATA= _.__/��" I --� -- APPLICATION ACCEPTED BY ------ =--t- - _t-------: .----------- ---------------------------------------- DATE y _ADDITIONAL COMMENTS ------- ---•---------------------- 0 ---------------- J--]E -� ` --------------------------- ----- = <<----•- -------------- ----------- ------------- -------------------------------------- -- NK NH'D `ip � p-------- ----------------------- - ----------- --------------------- ------ ----------------- _-$Q. t -----OF----P1Tcf[ - D�1Cr-------6------- V-F� 1 -- ----- I ------------------------------ �jj ------ -------------------- iC Final Insp 'on bY: -------- -- - -------------------------------------------------- Date -------- ----- -? - ---- SAN ----SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.