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E FOR OFFICE US : '� � " '• FLICAT.rOWF-6.lt SANITATION PERMIT AP Permit No. / (Comelete in Triplicate) -------------------- ----- , � Date Issued ...�-J� • 6-7n y / -_may__I__ This Permit Expires 1 Year From Date Issued --------- ! I Application is hereby made to the San Joaquin Local Health District fora per to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations! JOB ADDRESS/LOCATION F. ±_Zc1` `i -- --------------------- ------------------CENSUS TRACT -------------------------- Owner's Name ✓ ----------- -------Phone - +��- I.�.r- ,r Address -- 1_ --� lr..../ ------------------- city � It -a --------------------------------------- Contractor's Name -- ------------------ -- ---------------------------------------License # ------- ----------------- Phone --------------- ----------- Installation ---Installation will serve.-- Residence Apartment-House.❑ Commercial-❑Trailer-Court--;❑ �I F � Motel ❑Other ---=---~`--`--------�-ti---ri--d ---�--1--5- Lot 59�e . �� Number of living un s:.. - Number of bedrooms ..._-...Garbage G n_ ------ -- - ,7 - Water Supply: Public System and name ----------------------• - 1-------------------- -; Private ❑ r a I € Character of soil to a depth of 3 feet: Sand'❑ 'Silt,-E] Clay ❑ Peat❑ Sandy Loam Clay-Loam 23-- Hardpan ❑ Adobe .❑ -Full Mater al------------- If Yes,.tyPe ( (Plot plan, showing size of lot,ilocation of system in relation to wells, buildings, etc. must be placed on reverse sid'e.) NEW INSTALLATION:'+I (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) / PACKAGE TREATMENT [ SEPTIC TANK Size__ _ S' _1 .............`.. Liquid Depth _-..- -0(--- --- d p ,. Capacity ��-c3e7.-�j f e --- I Com artments --- C� /l Pro Line --- Distance to nearest. Well ----- --r-------------------- - Foundation - p , LEACHING LINEsKi No. of Lines _.?------------------- Length of each i 1 � line.._.----5i a----�---- Tot4al L�eng�h e�� �� aIr -�---.-----7----�----------- rial- -'bpt��FiltMtenai - -- -- - - -4- •-_ ALi D' Boxf--- Type Filter Mate --- ' Distance to nearest: Well .. .�__----------- Foundation .-. -.--.--_..-=- Property Line .. ...........:....'-_-- SEEPAGE PIT f Depth _-- __- Diameter -3�-,-- Number ....-�-.--._.....:_--Tgock,Filldd Yesg No,C3 Water Table Depth.- //4-- ' Y� .._ o�c Siz Line !,I t ` _Foundation .-J ..- Prop to nearest:-W,ell .---'� -- ----------------------- REPAIR/ADDITION(Prev. Sanitation Permit# ----- --------------------------------------- Date -----'---------••----;--• ��------) , } ------ --------------------------------i. L..- 1 Septic Tank (Specify Requirements) ------------ ---------------- 1 Disposal Field (Specify Requirements) -------- ---------------------------------- ` "--------------`------_-=------------- J ------------------- ,.-_•---•__._--_.--_._..1'.. .. ------------------------ I L--------------- i )}. (, ..._.---'-----------------------t_._--__.....- _ .. - --- - ---_--_--------i..-'-.----------------- -------------------------------------------------- .._._ - FP (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%' County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health District. Home owner or lichnf,, 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 becom jec o kman's Com sati.on-laws of California." �,..�. Signed Owner F -_i. ......... . ...... .... .y-...,_.._V .._._— cE c. ---- --- ------------ ---- - - ` r a ------------- By --------------------------- f =' r- ---':---------- ------------- -- - - ---- -- ------- -- - -------------------------------------- (If other tFian=_o`w'ner) Title -- - -------- - - ARTMENT'USE ONLY APPLICATION ACCEPTED BY --- - -:--- -` -- -- -----.-. DATE - ry -------- -- PERMIT ISSUED -.�------ -- _ _ DATE ---------------------------------- BUILDINGADDITIONAL COM ENTS` `= �7.1_-:.. � __ F L4. : -- --a ----- -- �-----�a�r� ---- -Z 7 `�� --- -------------------------------------------------- - -------------------------- -- E -" ----- ------ --- --- ----- --------------- -----------F------ ---------------------------------- D �l Final Inspection by: ------- - -------------------------------------------------------------------- ate �= r J AQUIN LOCAL HEALTH DISTRICT