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FOR OFFICE USE: PPLICATION FrV SANITATION PEP' 'T (Complete in Triplicate) Permit No. __.!_ -----.--------- ------- This Permit Expires 1 Year From Date Issued Date Issued -AI-P( _ 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 /NNo. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION _.. _ .�_Q. _ S _ Q�+'�7��(At'-__. .__Q�-_.1/�-�_e-___._.._ CENSUS TRACT ...__ ..___-_--_-_-_-. Owner's Name ------ •+_w!ts.C ✓IP�.�I.G/ - - Phone . ---- //ff-- sc /_ --- Address l- �,�-----4��- Tom--.-Com+-`v_as''- - -- ------------------ City bio-4,01,10n-------- �•�f --------------------- - - ---------- ---- -------------.License # ----------- - tone Contractor's Name _..__.__.__.___ _ . - Installation will serve. Residence ❑ Apartmf nt House❑ Commercial ❑Trailer Court Motel ❑ Oth-7 - ----- - ---- -- --------- ---- Number of living units: _, -___. Number of bed rp6ms ---A ___Garbage Grinder -__. ------- Lot Size ......0-a _ v---.------•--- Water Supply: Public System and name - -----` ------- -- - - - Private Character of soil to a depth of 3 feet: Sa7nE] Silt Clay`❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ HardAdobe ❑ Fill Material ------------ If yes, type __.-____________________._ (Plot plan, showing size of lot, locatiof system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic t rr( or seep a pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK [v) Sizzee_._____--_..__--------------------- - Liquid Depth -__._.__._...._-------- Capacity %L_ -___.-- TypeD_ _ . -- Material�n. _. No. Compartments -_'�.__. �� ane to nearest: Well t� - _.- -.------------Foundatio`n _w/1»�r!-_._ Prop. Line LEACHING LINE [ J/ Lines ._._._2- ------- - Length of each - -- - Total Length-- ength ___!-�X -------•----- 'D? Box Type Filter Materials,..- Depth Filter Material -..__._f�l----- i ----•�•----�� Zk 01 gtance to near�t:�W�JI. _ +(?--- -----------. Foundation �� _---- -- Property Line 4..... ---_-•--- N SEEPAGE PIT [ J �r'r --°--^= - .R� ---- ---- 1 Number __ ----------- Rock Filled Yes E] No - --- J er Table Dep ----- -E --- V -----Rock Size ---------•---•--------- V' Distance to ne t: Well _- __t._��___..--- oundation --------------- ---- Prop. Line _ -- ----------------- REPAIR/ADDITIOA eSanita#io rmit# ------- ----- ate -------- ;�--------, ) 9 � i Septic Tan (S Fify Requir nts) W 7 --------------.. - uirements) -------------------- ----------------- ------ T Disposal Fie (Specif �q -----------------------------•-------------------------�------ p ---------•------------� ----- ------- - - - - - ------------ --------- --•---------------------------- - Draw-------------- -existing--------- - --an- -d-- -required-- ddition a-------------on-----r -- ---- - vers .-- ----sid--e---------------------------- ( ) I hereby certify that I have prepared this application.. nd th t the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regula#idns oq f e�$an 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 beco ect to W n's Compens ion laws of California." Signed -- ------- ----------- Owner By - - Title y - - (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - -•-------------------------- DATE ---- -----7•��---�---------- BUILDING PERMIT ISSUED ---------------•------- ----•--------------------------••----•------------- --------------=--------------DATE - -------•---•-------•--•----------------- ADDITIONAL COMMENTS -------------------------•---•-•------------------•-•--------------- --•---•----••-----------•-----------•--------------------•-• - ---•--••--•---------------------------•------------- ------ -------------------•------------------------------ ------------- ------- ----------------------------------------- _� Final Inspection by: -- ----------•- -•------- - - Date .�'--- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M