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FOR OFFICE USE: APPLICATION"; SANITATION PERMIT - ----------------- L f .. a" `,i 4 Permit No:�1�-/_�-L_l�.`-_� - - - f (Complete in Triplicate) ---- This Permit Expires 1 Year from Date Issued Date Issued 1 -----------1.. Applicationis hereby rxiade-to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is made in com fiance with Count Ordina ce No. 549 and existing Rules and Regulations: i JOB ADDRESS/LOCATION / �1�- b t - ji` f► •�! f7 .f?�,�p SUS TRACT Owner's Name /�_� Efl/ ------------ ;. Phone t �4 Address ------------ f CityJ Contractor's Name ------ -- �/�>� -------------------- -------License #f,-'k -------- Phone ------------------------------ Installati on will serve: Residence Apartment House-E] Commercial:❑Trail&' ourt ;❑ Motel ❑Other -------------------------------------------- i f Number of living units:---yX.---_ Number of bedrooms 4/ � -----Garbage Grinder VX4 Lot Size / o---X-f� --.:_-_-_-_ r Water Supply: Public System and name -- ------------------------------------------------------------------------------------------------------------Private Characterof soil to a depth of 3 feet: Sand'E] Silt E] Clay E] Peat❑ Sandy Loam [] Clay"Loam ❑ { Hardpan ❑ Adobe NY Fill Material ------------ If yes,type -____________________-__ (Plot plan, showing size of lot",*`I.000ation.ofsystem-in.relation.-to,welIs,,buildings,etc:.must-be.placed-on reverse side.) O NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) " PACKAGE jTREATMENT ( ] 5 �CTANKX Size._ -X_9-f} °A ------ ----------- Liquid Dept _ ----_--------_ - T Capacity � _Q.11--- Type�G Material fj �_� No. Compartments ----�r..... ________ Distan�c�to nearest: Well ___ZZ,___----------------Foundation ------- -- Prop. Line __�----___________ LEACHING LINE No.,dfL'in`es ;Z--------------- Length of each line---- ------------- Total Length 'IRR.--f__'-e __ Box, ,�f�_._T-ype Filter Material` � Depth Filter Material -------------------------------- i - t Distance to nearest: Well __�,�_ �_____ Foundation __ �__�_________ Property Line ---4;' -/.............. 11 If Rock Filled Yes No SEEPAGE P,IT �(j Depth :.a .______ Diameter _____ Number ._Z-_ 1❑ Q� Water Table Depth -- `1 Rock Size l`r 2 be f Distance to nearest: We11 -----------------Foundation ---------- Prop. Line 4 ...... REPAIR/ADDITION(Prev. Sanitation Permit# A-------------------------------------------Date � _--_----____ -------------- Septic _--__.__--_- Se tic Tank IS ecif Re uirements ----- ) � ----------- I Disposal Field (SpecifylRequirements) -------------- '---------------------------------------------- ---•---------- !A --------------- ------------/ " �- ----------------- -------------------- ------------------ -,------- ----------------------------------------- -----.,.'_ -- ---------- ----- J V\---". ",�' :-------;------ Ikh(Draw existing and required addition on reverse side) #u. ereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rule Regulations and of the. San Joaquin Local Health District. Home owner or licen- N �a ,agents signature certifies the following: ' '"� � ai .1-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 atio;n 's Compens �laws, of California.';;, � �S geed =------- --- ----- ---�- r_-:__�_ Owner - ?Title ------------- ------ (If other than owner) . ARTMENT USE ONLY APPLICATION ACCEPTED BY --- - ------ -- ---------- - -------------- DATE -- -h-----�---` - ----------- ` BUILDING PERMIT ISSUED ------------ - - -------- - ---- I ---DATE -------------------------- �---------- f =----------- ----------------------------------- ADDIT NA COMMENTS ---'''--- --- --------------- ----------------------- ------------------------------------ _ - y � r - --'�- --- - -----------------�----- - ------�--� ---------- ---------------------------------------------------------------------------- r -- - - ---------------------------------------------- - ----- - ------ - ---I- ------------------------- ----------------------------- ---------------------------- ------------------ - ------------ Final Inspection by: ------------ - - ----- -- - Date -------/� ter' O {JUIN LOCAL HEALTH DISTRICT E E. H. 9 1-'68 Rev. 5M.