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FOR OFFICE USE: APPLICATION ICOR SANITATION PERMIT �� ---------------------------------------------- Permit No:'- ------------------- (Complete in Triplicate) 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/LOCATIO � �- ------S----------- _0A1--------------i C------CENSUS TRACT ------------ .*._._. Owner's Name --------- -Q.�--------BR-0 N 0---------` `------------------------------------------=---------------------Phone ------------------------------------ Address -----------Mf X------ 5 - EX-M 'U-------------------•- City ` -`------------•---------------------------- Contractor's Name ' '` -_----.License # "-- Phone Installation will serve. Residence Apartment House❑ Commercial ❑Trailer Court ❑ Motel ❑Other -------------------------------------------- Number of living units:__.__----- Number of bedrooms ___:___Garbage Grinder ____ Lot Size -----------___ Water Supply: Public System and name ------------------------------------"------------------------- ---------------- -------------------------------Private ( - Character of soil to a depth of 3 feet: Sand'E] Silt❑ Gay ❑ Peat Sandy Loam -[§lClay Loam i Hardpan,E] Adobe'❑ Fill Material s'�__ If yes,type --- ' (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 seeps it permitted if public sewer is available within 200 feet,l " 10, PACKAGE TREATMENT [Q- SEPTIC TANK'[ y Size___J____X__lR_X__6___________________ Liquid Depth Capacity _l_ e_L_� ------ TypeI4EQR57T_ Material- - No. Compartments __ _____________ P 61 stance to nearest: Wel! __7 _______ ____________________Foundation ---/e__ _____.___ Prop. Line ____LQ-._=__-_-_-_ LEACHING LINE No. of Lines -------9- ----------- Length of each line ____ ------ Total Length 1��.- ............. �p � it ox -__I-__.___ Type Filter Material �_L��__.___Depth Filter Material ----�e-------------- ___________________ Dista x r e. P nce to nearest: Well __-_7�'______________ Foundation ----/P Property Line_ /�_.._.__.._._. Rock Filled Yes No ' SEEPAGE PIT Depth -- l f- Diameter __21_�_ -_ Number _- @- ❑ Water Table Depth -----3P------------------------------°------Rock Size ----t.------------------------ Distance to nearest: Well ----lD__G'___________________________Foundation _-'`f?------------ Prop. Line _: -______._..':_.. REPAIR/ADDITION(Prev. Sanitation Peit F# --------------------------------------------- Date ---------------------------------- , I Septic Tank (Specify Requir Meats) --- - ----- ----------------------------------- -------------------------- _ ------ -------------- Disposal Field (Specify Re uirements) ______________ ____________-_=__-----_-__--------- i ------ ----------------------------------------Land ----------------------- -------------------------------------------------------------------------------------------------------------------- i, aw existing and required addition on reverse side) I hereby certify that I havethis application and that the work will be done in accordance with San Joaquin County Ordinances, State Laules and Regulations of the. San Joaquin Local Kealth.District. Home owner or licen-sed agents signature certifies "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 subject to Workman's Compensation laws of California." Signe --' - --------- -- ------- - --- Owner. ----- - .l�, ,, RP BY - 1 � '1�--- •Title --------- ---- ------ ------------ (If -- -----(If other tha6 owner) FOR.DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------- -0 •- _" ---------------------------------------------------- DATE -----7n.��_".7 --- ----- BUILDING PERMIT ISSUED --------- --- -- -----DATE ------------------------------------------ ' ADDITIONAL COMMENTS ---- -- - ------+ ' `--- '---------- --- ------------------------- --------------------------��----------------------------------------- ------- ------------------------- --- ------------ y - --- ------------------------------------- ----- -- ---------------------- -- ----------------------------------------------' --------------- ---------- �.y - ------- - - Final Inspects j� _---- --`�`� ` ` \ 'L��L - - -- -- -- ---- --- ---- --- ---------- ---- --------- .Date ----- ------ Final ------- ------- ---�---- SAN JOAQUIN LOCAL HEALTH DISTRICT ` E. H. 9 1-'68 Rev. 5M k