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FOR OFFICE USE: APPLICATION1;. SANITATION PERMIT .......................................... Permit No: ..7:....: ° r;W (Complete In Tripiicatel . ..........I.......--------•----------------............... 7 -f Date Issued 7; ....................................................... This Perrnit Expires I Year From Dot*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 S JOB ADDRE5S/LOCATION ........ - .3J�,3 .._.___.. CENSUS TRACT .......................... Owner's Name ----.--AlX ....... .................................Phone .5�7,e ------------- Address _... .. �� _..... .....;01) 1.6er__b............ ............C# `/.r^�) Contractor's Name ---.---Af .------•..............•---------.License # cr' �.5�P% Phone :2.3..V'..'�� Installation-will serve:�.Residence;ff Apartment Housef].Commercial O7rakler-.Gourt�;0 a ' Motel ❑Other......-".................•-••---------._.... -- Number of living units: ... Number of bedrooms .,`....Garbage Grinder ............ Lot Size!... ............................. a . Water Supply: Public System and name ......•------------------------------------------------�=.�,�•.�"::':....:-.,::`:':._'............. ....Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Ciay ❑ Peat❑ Sandy Loam !o lClay Loam ❑ Hardpan Adobe 0fill Material If yes,type 3 . � (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,) PACKAGE TREATMENT [ ] SEPTIC TANK 1 ] Size--•��!'j-�` .................... Liquid Depth ...5.1�..f.......... Ca aci f I I p tYf dT> Type fl. cam_ Material---•------------------ No. Compartments ....' ........... .""i3istane to nearest: Well --- 11---------•-•--•------- Foundation .-/10,�.. . __ Prop. Line ...................... .. LEACHING LINE No. of Lines ..... !�.______.__- Length of each line..___ G� Total Length �Q........... . [ l - 9 ............. s 'D' Box,.. ...... - TYPeFiIter.Ma#eri�al f�,�?X .kDepth .Filter Material ............. 01 Distance to 0prest ,WeII / - ..Foundati`on`s _" Proper tine .f�l�.............. 0 , SEi+P� AG1= PIT [ Depth ...........�, DiaMeter ........-........ .-----...-- ...- Rock Filled' Yes ❑ No C) Water Table'Depth -----------------------------------------"--Rock`Size"4.........._.... .......`... y� Distance to,nearest: Well ------------ :....---..Foundation .................. Prop. Line ......................y R PREPAIR/ADDITION(Prev. Sanitation Permit a# •-• :........_. ...___...-..._._... :.=.=VDate. - f - Septic Tank (Specify Requirements)` �:......: I ......... Disposdl Field (Specify Requirements) .-.........................----•---....._...._..--..-_"---•---"------------------------.k_... ..................... F -------•------------------------• - ; -_ (Draw existing and required addition on r--------------------...---•_......__,..:.__........_._.....----•----......._. ` everse side) 1 hereby certify that 1 have 1lz pared this application and that the work will,be done in accordance with San Joaquin County Ordinances, Staid"Laws, and Rules and Regulations of the San Joaquin Local Health.Dlstrict. Home owner or Ilcen- [ sed agents signature certifies the following: t "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 /subiec o W _kma 's ompensation laws of California." t Com : x Signed ..... ll _.._.. '�- --.... Owner : . �, BY ....... 34 --------------------------•------- --- . _, ..__ . . .... ...-- A o#her tianowner) R MENT US.E: CINLY J _ � i APPLICATION ACCEPTED BY . ...... .. , G+'L-� ........................................ DATE .:............W......._.....__....,.._:.. BUILDING PERMIT ISSUED _-- -------------------------•-•- ------------------ .,... .......DATE ...... - ---------_........... ---.----------' ADDITIONALCOMMENtS -----------------------------------------------------..................................... ................................. •....... ................. --------------------- --------- ----•------------------ ---------------- ---------------------------- ----------------•.... ._.. r .....�.- Final Inspection by: -------•------------------------- :. " Date .. `��......._ _ .. EH 13 A 1-68 Rev. 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h- 3M '