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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT //(�Jj C(��''77 w Permit No. .tL1__!_:_L_-!--o. -------------------------------------------------------- --- (Complete in Triplicate)---------- ------------------------------------------ - Date Issued -6l:. •= This Permit Expires 1 Year From Date Issued Application is hereby made to the San:Joaquin'LocciWealth-Distri�. .for a permit to construct and install the work herein described This application is made1 in compliance with County Ordinance No. 549 and existing Rules and Regulations: �r _ t TRACT ---------------• --------- t� JOB ADDRE 5 LOCATION .-��_��'-��__f I�-- : `'�'c`-- -- � fid'°'----,4 - GE, 1 _41`. _� ------------------------=--------------- Phone Owner s Name -_��--��#-. �- -4--- � Address r— _ l-. -- .-- ------ City s 's Name _ = B �---- Ouse' ---------- Contractor .Litense # � Pone { Installation will serve: Residence �]A tment H D,Commercial ❑Trailer Court ❑ Motel ❑ Ot l er ----------------- , 1V47-_ , ------------- Number of living units:___`_---- Number of bedrooms �Garbage Grinder _ '_ Lot Size _ _- E - }� r Private ®, Water Supply: Public System and 'name -------------- -`-•�. ----------------- -$ - - Character of soil to a depth of 3 feet: 1. Sand' Silt F1W Clay .❑ Peat ❑ Sandy Loam ❑ Clay Loam .E] I[ardpan O:Ado ❑ a _ -...�.c,... - - ----------------------------- id be. Fill.M tenial ____ If.yes,:type -- ----- .- _--- Plot Ian, showing size of lot, location tion of system in relation` to,wells, buildings, etc. must be placed on reverse .side.] ' [ p ' feet,) ` lJ ®_- Liquid pe th - ---.._. y NEW INSTALLATION: {No septic.tank-& seepa � pit permitted if Public sewer is available within 200 feet) SEPTIC TANK' :° Size,SaC_1 �C_ q P PACKAGE TREATMENT [ ] G''1� j �' iI men,t-sl-9-._._-.- ........ Capacity --- aterral- l-LNo. Com part istance to nearest: -We -----°--------------------------Foundatio I_6---------- Prop. Line --�--------_--•----- �I ' ------------------- Length-of each line.----.-- -..---- Total Length LEACHING LINE fol4o. of Lines - Al E � '4 t 4 Depth Filter Material 'D' Box Type Filerter{...M - lMi aerrpl _ / ; Distance to nearest: Well ge _.______-- Foundation _____�_a_------- Property Line ___6______-__t....___ De th Diamr __------------- Number -.__--------_---.----------- Rock Filled Yes [I No 0 SEEPAGE PIT [ ] p --------------- Water Table Depth -�----Rock Size --- -- ,1 ---------- --------------- _ Distance to nearest: We'll -fir -. Foundation Prop. Line------------------------ k....... t REPAIR/ADDITION(Prev. Sanitation Permit# _.__'__. ---------------------------------------- Date ------------------------------ --} ` --- Septic Tank (Specify Requiremdnts) ------- ------------------------------- i I __ Disposal Field (Specify Requirements) ------------- - -- -- ----- -• -- --------- ---- ---- � i_ ry ---------- �• -- --------------------------------------------is ,.•.- ----------------------------------------------------- --------------- 7 (Draw existin nd re wired- '---------------------------------------"------------------"--- -- - - --- - - ----- ------ - ----- ------------- - --- g q_ _ addition on reverse,side) 1 hereby certify that I have prepared this application ci that the work will be done n accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations at-the San Joaquin Local H1 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 I as to become subject to Workma 's Compensation laws of California." Signed --- ------------------- ------- Owner B ` �y-{n Title --------------- -------- -------------- -------.-------- (If other than owner) (tt FOR DEPK*TM-ENTVSE..ONLY q APPLICATION ACCEPTED BY _.�_ER-C -----------------------------`�-----------i--------------------------------- DATE ---�f-` /Y-- ----- ---- BUILDING PERMIT ISSUED --------: -- ---- DATE ---- ----------- ADDITIONAL COMMENTS [�lot' Ilfl { � _ --- ------------------------------------------------------------:----- -"-------- --------- - - --------- ---- - -------------------------------------- -------------------------------------------------- - ---------------------- - -------------------- -- ----------------- Final Inspection-by' - --- ---- ----- ------------ Date --- - - -l' -- SAN JQAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M