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FOR OFFICE USE: .APPLICATION FOR SANITATION PEI( )T :,` 'Complete in Triplicate] Permit No: __:�,�-_-/93 a JI - --------------------- ------- --- ____ _ _-- This Permit Expires 1 Year From Date Issued Hate Issued Application is hereby made;to the San Joaquin Local Health District for a permit to construct and install the work herein F, described. This application his made in compliance with County Ordinance No. 549 and existing Rules and Regulations: Lr / JOB ADDRESS/LOCATION .. -------O OR nP13.87 --------- .-- --CENSUS TRACT ------- -------[VAN--------- _#9 S Owner's Namef �1 -------- --- ---- - ---------- Address ------� 45 33_ ----------f L7_MP_ ---------------- City --�CA-ONone-------------------------- -•---- Contractor's Name __ATTERVS-QX - ----------------------------------------------License # ------- ---------------- Phone --------------------_------- Installation will serve: Reside cnce ❑ Apartment House❑ Commercial❑Trailer#-•K}� Motel ❑ Other -------------------------------------------- Number of living units:----_'j/__ Number of bedrooms ____Garbage Grindery Lot Size - AMFW6_�----------- Water Supply: Public System and name ----------------Private Character of soil to a depthiof 3 feet: Sand'El Silt Q Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam 2__10 Hardpan Adobe'❑ Fill Material ------------ If yes, type ___________________-___ {Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.} w NEW INSTALLATION: {No septic tank or seepage pit permitted if public sewer is available within 200 feet,] PACKAGE TREATMENT SEPTI TANK � � 1L- - - - Liquid Depth -----��----------- Capacity __� p.,._ Type PLASM Material fi� CLA�lo. 4oTpartments _ ....___...__._ } Distance to nearest: Well _____-_.?��_ST" ___________Foundation --_--lQ__ `- Prop. Line ____._ _�'__ LEACHING LINE Vr' No. of Lines -----�---_--___-__ Length of each line-------- 0_____________ Total Length ,jf49_________-_-__ 'D' Box11 Type Filter-Materia! _ __ 1 � __Depth Filter Material e ��' t Distance to nearest: Well ;_ __^ "":___ Foundation -_- __-_ Property Line ..�. ....___ SEEPAGE PIT ;0501l Depth -----� _� Diameter _x hl --Number ._______ . _ _ Rock Fille Yes No i Water Table, Depth ______.,'�________,. Rock Size -jOff Distance to nearest: Well _______ :.__.__.. •- ._.Foundatio ---/49-47- Prop. Line l��__-_'�" El REPAIR/ADDITION(Prev. Sanitation Permit# _______--_________________________________ Date _-,______-__________-___-________-} Septic Tank (Specify Requirements) ___________________________ r Disposal Field (Specify Requirements) ------------- ------------------------------------------------------------------•--------------- --------------------------------------------------------------------------------------- I ------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin i 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 any person in such manner as to bec'o ct to W man's Compensation laws of California." i Signed ------------------------------------- Owner By ----------------------------------------------------------------------------- — fir Title ---- ---------------------------------------- (If other than owner) ; { FOR DEPARTMENT USE ONLY iAPPLICATION ACCEPTED BY -----1 `i?-99----------------------------------------------------------- DATE / - �7a--------- BUILDING PERMIT ISSUED ----DATE ----------- ADDITIONAL COMMENTS ---- 1 - t ! ' cr A-x!_�`1-r-`-d-�:� -� uvv I-_=I-- v CEJ $t ' � Iury r __ _ _ -r------------------- ------------------------------------------ = � . -------------- ------------------- _ Final Ins ------------------------ SAN ----- ----------- Date - r SAN JOAQUIN LOCAL HEALTH DISTRICT K. H 9 1.'AR Pau 5M