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FOR OFFICE USE: a. a <br /> y APPLICATION EOR SANITATION PERMIT <br /> ------ ------- ------------- --•- <br /> {Complete in Triplicate) . Permit No. <br /> -------------------------------------------------------- <br /> >r Yf <br /> ----------------------------------------------- -- - <br /> _____ This Permit Expires T Year From Date Issued ao ': Date Issued <br /> r , <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct;and install Ithe work herein <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION .__--------_3 ---------- - ------S - r' <br /> -E-P� . �GENSUS TRACT __ <br /> Owner's Name ------- ---RQir------ ----------------------- <br /> -�f --- ---Phone-A...----`. <br /> Address ----R 0 zBOX--- .3-3 -----/Q =--T�T RRS---------- City 009 K 1 t <br /> -------------------- <br /> Contractor's Name01A1N. 3 ----------------- P Trailer C Phone ---------------_--------•----- <br /> --------------- ---------- ----- ---.--License # -------- <br /> U <br /> Installation will serve: Residence artment House❑ Commerci I':❑ ourit <br /> Motel ❑Other--------------- <br /> ----------------------­----- <br /> Number <br /> --------------- ---Number of living units:---.------- Number of bedrooms __3_____Garbage Grinder AD---- Lot Size _ _r�_� 000 h + <br /> 1 -------------------------- <br /> Water Supply: Public System and name ---------------- --- --- -------• - -- --------,- - #-_ -!Private <br /> Character of soil to a depth of 3 feet: Sand silt clay Peat Sand Loam i��Ciay(Ldam . <br /> ❑ ❑ Y ❑ ❑ Y' t Y ❑ I <br /> �� <br /> " anHard-PAdobe ~ <br /> '... - ❑� Fill Material"--0-:771 f <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc, must -be placed on reverse side.) <br /> 1 <br /> NEW INSTALLATION: s <br /> (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ 1 z i <br /> [ � SEPTIC TANK Size--- -- - -�Q--X------ - --- =- <br /> r ....�- - - - , 3 Liquid Depth:-----��------------ <br /> Capacity _1'z_0.8::`. ,Type -- ___ _ Compartments <br /> ---------•-------_--- <br /> if i <br /> Distance to nearest: Well _ - -� aterialFoundation _1 o!---__-:_: prop. Line ______________________ N <br /> LEACHING LINE [,r--'No. _ ' (�" `''� ": I '7 Q <br /> of Lines --- '_- -- 'Length' f each f! e_-_---�-- <br /> ►. ,r Total. Length rs ---- ,! <br /> D' Box . Type Filter Material 1 > _z-Depth Filter Material l9__.__ <br /> t <br /> i <br /> Dig# ce- r earMZt!"Wfari Y p�tty rne. S'' - <br /> r l�bCdaron Prop <br /> SEEPAGE PIT (� ""'13rarn ock� <br /> ..wWdater�-abie.Deptla�; R - "* ��• <br /> - ._ oak Size =1 - <br /> D e �--------------------------------- �'n apron __ '}- Prop. line _.. � <br /> - W�-11 VJ <br /> _a___- <br /> REPAIR/ADDITION�PrevYSanitation�Permit# - Wi-11 VJ Date -----------------__- ---___-'� <br /> i <br /> Septic Tank (Specify Requirements) -- <br /> -- -------------- ----- ------------- <br /> ----------------------- <br /> Disposal <br /> _ --------------------Dis osal Field (Specify Requirements) CIVAt-G ----_ _fQSir1 e--------- ------------------------- <br /> _ <br /> L_ <br /> --------------------------------h6tt..____ x �--------�------------ - --------- T <br /> p_ --�- _ -V, �4_------------ <br /> (Draw existing and quire�c addition on reverse side)., <br /> I hereby certify that-I-hav prepared this application and that the work will be d6ne in accordance win San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local{'lNealth District. Horne owner or licen- <br /> sed agents ignature certiffiek the Following: <br /> "1 certify th tin theperf r of the work for which this permit is issued, I shall n�rriploy any person in such manner <br /> to 1 <br /> as to be a subjec ' arkm ' .Compensation laws of California." ; 9 <br /> i <br /> Signed <br /> ----------i------------------- --------- Owner <br /> -- ---- - -tl <br /> By t - Title --t_[ <br /> (I other than owner) II '. � <br /> FOR .DEPARTMENT USE ONLY <br /> �— _ y <br /> APPLICATION ACCEPTED BY -----t_'_i R-_�'- r - DATE __ ZrCr-_7 ' <br /> BUILDING-PERMIT-ISSUED`- --- _ -DATE---- -__- I - <br /> ADDITIONAL COMMENTS _-- _ __-- _ Q- _ #- `F <br /> C kCsl ! ' <br /> --------- -- -------- <br /> ---------------------- - ----- - - -------------------- -- ----- <br /> Final --------------- --------------------------- <br /> Final Ins - - ----- ---------------------------------------Date ----- � - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H..9 1-'68 Rev, 5M <br />