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FOR OFFICE USE: AIaPLIG47ION FOR SANITATION PERMIT z Permit No. . �� 3 ...... ----------------------•-- -------------- ------- (Complete in Triplicate) c 6 n v✓ ---- ---------'-----------'----------- i ,t " ------� � ----- - - ._l Date Issued --.._----------- -- This Permit Expires 1 Year FromPDate Issued , Application is hereby made to the San Joaq'jin Local Health Districttfors_a permit to construct and install the work herein described- This application is made in compliance with County b'rd;inanee No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCAT N I L - ��' !==" ' ; f CENSUS TRACT 's Name Lt1- `1- CSr__ 7_!`J?- - t - ........-----------.-Phoned- Owner -------------- I------ AddressCity .- Gff: .. ate _1 hame --------- .... ' LicenseQ-- Phone----- � ----------- Contractor'sInstallation will serve: Residence [Apartment House❑'.Commercial ❑Trailer Court Number of livingunits: _�-__._ Number of.bedrooms Garbage Grinder -- Lot Size -- �.. ?.�r`7t Water Supply: Public System and name -----`- ----- ---------------------------------------------- Private Character of soil to a depth of 3 feet: Sand;❑ Silt El Clay Clay 1 Peat F1 Sandy Loam Clay Loam [] Hardpa, ❑ Adobe-[] Fill Material ------------ If Yes, typ a ---------------------------- (Plot ----- --'------- - "(Plot plan, showing size of lot, location ofsystem ,in;relation,�t"_wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: iNo septic tank or seepage pit permitted ifpublic sewer is available wi#hin 200 feet,} PACKAGE TREATMENT { ] SEP TANK` Size__�-� -- ------ -- -- Liquid Depth��------------------ �j�, c # e,0 � Material---------------------- No. Compartments v`�-------------- Capacity/.U�- .-5 TYP / Distance to neare'ii.' ;Well __ZQ!?------------------- --Foundation �C?-_------------ Prop. L00 ine -L --------- 1 / LEACHING LINE [ ] No. of Lines �-- ------ Length of each ine- ---------- Tota! Lengfih --------------------- �� De th Filter Materiai/� ----------------------------------•- d/ 'D' Box __�-- Type Filter Materiri� --- ------- p _ ------ Property Line --------11-------------- Distance to nearest: Well .......... ......b,__ Found4tionyi___.____._ p tY i " ~ �� Rock Filled Yes �No i❑ SEEPAGE PIT [,] � Depth-��=--'--- -- Qiameter �- ---- - -- -------- ----- -- •..-, � r e1 � .. . . , ., um k Number n.. s = =----=Roc Size Water Tdble De th :' ,-- ` `fir s J�o s Distance to nearest: Well __ /D'�--------------------------__ _Fours p �j i . dation �1� Prop. Line _.-. REPA (Prev. Sanitation Permit�# --- .-..'--- ------------------------------°., IRJADDITION Date --------------- ) 1 {---------------------------------------------,.___-_____-_---______-_____-. Septic Tank (Specify Requirements) --------------- '---- _____________ • 6 Disposal Field (Specify Requirements) ----"------- -- ------------------ t ! ----------------------- -------------------------------------------------------------------------- ------------------------------------- ------------------- ---- ----------------------- r 4------------------------------ --------------------------------------------#---------------------------------- — - _ ' (Draw existing lgnd..regyi.red_additi.on_on..reyerse side) I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health 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 an person in such manner 9, as to becom bject to Workman's Compensation laws of California." .� e--------- --------------- _s " Signed _ ---��- _ ------------------------------------ By ' - --- ------------ --- ------- Title hf of er than owner) FOR DEPARTMENT USE ONLY � } "; "` "----------- DATE . _7-_—___- - ------------- APPLICATION ACCEPTED BY - DAT "' -------- i BUILDING-PERMIT`'iSSUED ` ` " " ------ '" rRJ;�3 i~ .�. ---- --- --- ---- ADDITIONAL COMMENTS -- --- :. � L - _. _ - _.---. r _ - ---------------------- -.._ - �.. - ---- --------------------- ------- -------------------- ----------------------- ------------- i - -- ` -- - --- _,€ -- ---- ._ _ _ _ rw 4 ---- -.gate -------- --------- - •� �' ------- Final Inspection6' . - -l " SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M -