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AOR CTr"FICE USE: " �� y �. APPLICATION- R SANITATION PERMIT ........................:..... Permit No. . --- {Complete in Triplicate) ................... Thls)Pernilt Expires t Year From Date issued Date Issued . Application is hereby made to the San Joaquin Local Health District for a permit.to construct and Insdescribed. This application is.made in compliance with County Ordinance No; 549 and existing Rulestalnd Regu athertions.�ein JOB ADDRI=SS/LOCATION.....y � f� � / �_I----- --- --------rsl,.l..._.C�.,P�.:�,.. �C>i ......CENSUS TRACT .... 6. + -Owner's Name lJ. tl ^<rf-�_ �.1-�-�t�S' �g ......... :t_�f. 7. •Phone ty Contractor's Name ..-----0. �/L - """'� ........................................ . ------•-- A•••-•-•. ---•........License # !.... ..---..... Ph � , - one ..��................... .Installation will serve: Residence partment House] Commercial QTraller Court Motel ❑ Other ...;..s.. ':::--•--...--••--•...__...... ,r Number of living units:___;. 1. Number of b rooms ._. Garbage Grinder A/ Lpt Size . •-�1 -•-_:• Water Su _ pply: Public System and name ... _ l'� d .....: /..�. Character of soll to a depth of 3 feet: Sand -private [c�� . �'' Silt Q Clay ❑ . Peat❑ Sandy Loam Clay Loam j] \ Hardpan ❑ A obe o Fill Material ...-_....... If yes,type (Plot pian, showing size of lot, location of system in relation to wolfs, buildings, etc. must be placed on reverse side.) v NEW INSTALLATION: (No septic Manic or seepage .pit ,permitted if public sewer is available within 200 feet,l PACKAGE TREATMENT JI SEPTIC TANiCf IZ�Xis�/�+J Size_ [2_©--- ..{... _ Liquid Depth k Capacity lop-------. Type.C�� Material..........`".... ....... No. Compartments z , . Distance to nearest: Well -1(: i1, . ..............Foundation �_. .... Pro LEACHING LINE w•-....... p. Line ....,/No. of Lines ----=...__ 9 � !i1 —'` �� e i Len th of each line._ .�_ "Total Length D' Bax __..L/ Type Filter Material /C.� Distance to nearest: Well -e--Depth .Filter Materia) �.�1--o ,� / � � -... .. ............................. ..._..__/40------- Foundation /_ ..... Pro e SEE41 ��T Property line . t ] th -- Diamet Nu ber __-- ------ Rack • ed Yes _N Wate Table Depth - -=--••----------------- ................... Foun anon .._.._........ ..... Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ............. pate ....... ---- Septic Tank (Specify Requirements)._.. ��_ �-�� ,�� /P li ... *PY�4�.........._.. Disposal Field (Specify Requirerrients) .............. ----- . ...... ........................ .................. f ----- -------------------•- _.... ------------------- -------•---- ----•---------• --------- --•- ...-.................................. ......................................................... (Draw existing and required addition on reverse side) I hereby certify that 1 have prepared this application and that the work will be clone let accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin tocol Health,iDistrict.Y eme owner or licen- sed agents signature certifies the fallowing: "I certify that in the performance of,the work for which this permit is issued, 1 shall not employ an ' p Y y pet n In such manner i as to beeorn ubrk n's Compensation laws of California." Signed ;1ect - --_------------------ •------------- Owner By ------------- ----------- ----------................. ------ --- - - -- •----._._._ Title - (If other than owner) _....- ....................... FOR D ARTME T USE ONLY APPLICATION ACCEPTED BY ------- ------------------i_.- _- - /9 DATE .5-.--.-. BUILDING PERMIT ISSUED .-.------ - DITIONAL COMMENTS ---- ---------••-1..._._..- ••---------•- --•----• ...........DATE ......... ................ -- ----- ------- ••--•-- • -----........_.--•-------•---------------------•---------------.-----•-•----....__.....---- ----••---------. ................... Final Inspection b ------------------ --.....-----•----------------- •--...._._..Date EH 13 2L 1--68 . liev. 5m IS /� -6._...---- SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M