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4 FOR OFFECE USE: ApplICATIOW FORSANITATION PERMIT Y (Complete in Triplicate) Permit No. -- - -- --�---. ----------------------- 6 s'73 Date Issue -------- -------- This Permit Expires 1 Year From Date Is Application is hereby made to the San Joaquin Local Health District for a p t t o str t nd '+ Oe4work herein described. This application is made in compliance with County Ordinance N and t' gRegulations: JOB ADDRESS/LOCATION -7-7.-_ - - . --- YR - - E00b CE S RACT - _--_.--- Owner's Name. ---- -�- - yy- if �. j� iq Phone -------------------------- AIR Address''-------- ------------- - s----------�-----\---------------------------------------- City - - �. Contract'or's Name=,4,* P ACK+-/ -Q .License # ----_------------------ Phone --------------..--------....._ Installation will serve: SResidence ❑ Apartment House❑ Commercial :❑Trailer Court ❑ Motel ❑ Other -------------- --------------- -------- - � ' units —�-.- Number of. bedrooms-_----Garbage Grinder -4 Lot Size -------------------------------------------- i ---- _----_-_-_ Number opl�in �' 9 Water S I Public System `and name -----\'-----_ -_\----------------- - -- _____ Private ❑ k Character of soil to aide thiof.3 feet: Sand \Silt E]\Clay Peat[]) Sandy Loam ❑ Clay Loam ;❑ Hardpan Adobe If-y_s\, ------------------------- be '.f"- a: Fill Material 0 e =-_= = (Plot plan, showing size of lot, location of system m,relation 4:o wells, buildings,, etc. must be placed on reverse side.) �I NEW INSTALLATION: (N septic tank or seep p perrmittedtif'public sews is available within 200 feet,) ` ��' ,. : , c PACKAGE TREATMENT {;�]5.. TeS'TANK' 4 •Size-_--f_'`xl d___ _J__. _____- Liquid Depth ---- -_--------. -- ,------ Type J i -�fMaterial if Compartments -- I �} Pro Line ----5- _ r-- t: Well ----J-o. '----------------- undatio` ---I9----------- P =f stance to neares LEA( IG LINEo. of Lines --_ ------- Length of;each line_f_4�-------------- Total Length ___ 0____.-_-__- /J D' Box . - 5 Type. Filter Mater( -It------.�-��_^�—__Depth Filter l�Ilatenai ___, -_-_----------------r .. \ w j Distance to nearest: Well - _ 7 Foundation ____.1---- Property Line --_- f AC, k. \ / \\ \ ( p Diameter 110Number ----- ~�f---- Rock Fill d� Yes No i❑ a th.; /. f , t /(. Wate"r�Table' 17epth\_____�?--�-4- - -Rock Size\_-J �r - -- �- Distan`c� to`neares#: Well ______,? _._____ __.-. Foundation ___/fs__ =- Prop. Line -------------_________ REPAID/ADDITION(Prev. Sanitation Permit# _---_-__.- �� I ---------- - ----------------- - - Date --------•--------------- ) Septic Tank (Specify Requirements) ---------------------------------------------------------------` ----------------------- -------- - - Disposal Field (Specify Requirements) --�'---------------------` - ------------------------------ -------------------- ----------------- -----------------------_------ •-------- - - - ---------------------------- ! 1�f*` ---- --------- -------------------------------------------- ----------- ----- - ---- ---- ---------- ---------- - >, -� (�Di•aw-existing'and required`addition-onrever e,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 Locdrl Health District'\'Home owner or licen- I, sed agents signature certifies the follow' g: "I certify, t t in th erfo nce of work for which this permit is issued, I shall not employ any person in such manner as to be6 ub' to man's pensation laws of California." Signed . �� -_ -.-'.----`..._'Owner - - - �- 01 BY --------d----- Title -- --------------------------------- (If ------------------ ---- iF (If other than owner) + FOR .DEPARTMENT USE ONLY ,-- --t-- - V 3 ---��Z------. DATE ---------- BUILDING ------- BUILDING PERMIT ISSUED ---------------------------------------- =!! - ---- APPLICATION ACCEPTED BY _=-------•---h--� `------------------------- -- ------ t ; ;.--t--------ifl. --DATE ADDITIONALCOMMENTS ------------------ ' — ----------------------------------------- --- -------------------------- -- ----------- } ----------- " ------ -` ` r r I---------------------------------t---------------t-------------------- -------- --k— ------- _.c . �_ '_" -------- - -- -------------------------------------------- ---------------------------------- ---------- 1 -----�---' -- r,. D --. ate --- ji FinalInspection . ---=---�'- -- -- - ��- - --- ------- --- -�#- -• -- ---�-�------------------- ---- -----'�-- ------�--- - ��A "- T--' SAN JOAQUIN �OCALHEALTH DISTRICT E. H. 9 1-'68.Rev. 5M