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PLICATION FOR SANITATION PER (Complete In Triplicate).................. Permit No. .... .5......Y3 ..... •••••--- ...--- This Permit Expires 1 Year From Date Issued Date Issued .../Issued Application isthereby made to the San Joaquin local Health District for a permit to construct and Install the work herein described. This tapplication Is made In compliance with County Ordinance No. 549 and existing Rules and Regulations, JOB ADDRESS/LOCATION ../.-/.. � .i _.Q, Q Owner's Name - '"�- CENSUS TRACT ... ._.._ ............... . . . -- �-..,.- - .. �.1 , ...................................... ............................ •-- . ............Phone ................. Address _. _--•--. City - ...... ....... Contractor's Name . - --C,v�Tc,� � �/J�/i`� a, �...............License # ,�-...�'D!�-�.- Phone ��e��.�fQ--•-- Installation will serve: Residence Apartment House 0 Commercial ❑Trailer Court ❑ Motel ❑ Other Number of living units:__.--- Number of bedrooms . ....Garbage4.`li Grinder ..._.._. Lot Size ... Water Supply: Public System and name _______________ .......................................... -------------------- Private. Character of soil to a depth of 3 feet: Sand V Silt E3Clay ElPeat F] Sandy Loam C] Clay Loam ❑ 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.) NEW iNSTALLAIION: (No septic tank or seepage it permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT ( ] SEPTIC TANK fVtl 1 S --•--- Liquid Depth ------------------ 9 J Size__ -C�Rd._:. .�r // ------- ��Q�j 64" 46j" Capacity /..04:16-------.. Type ecATC.......... Material_C-O.ItC��1!�- No. Compartments .Z-..............-J i,k1:711NS Distance to nearest: Well __..3t 3 / 1 i J1 ---Foundation _./O..IL-------. Prop. Line .5:�............... ^ LEACHING LINE [ J ' No. of Lines _.. � ----------------- Length of each Iine...�Q..-_---.---.--.... Total Length ..��--•---•------.._.. p//t pelf i D' BoxCOsa•G/.- Type Filter.Material/��:Z-_I��c:rDepth Filter Material ZQ.��................................. grn �� Distance to nearest: Well _. a_Z�..-__---. Foundation /Gr. .......... Property Line .., ?�...._. SEEP Diameter ---------------- Number _.- Rock Filled Yes ❑ No ❑� Wetvshfp---------------------------------------•--------Rock Size ------•------ ----- - -----...._ V' ell ----••-----------•---•-•----------- Foundation ----------- -------- Prop. Line ......................"It- REPAIR/ADDITION(Prev. Sanitation Permit# ------------------------------------------•- Date ---------------------------------- Septic .--•----.----_- -----Septic Tank (Specify Requirements) .---------.........-_-. . Disposal Field (Specify Requirements) ---S9O.0:14 Vr-------------- ' Q Cam1.6 •---- ---- •----------- ------ -- ----- ) --------- --------- -------- ------------------ --------------------•-- ------------------................... (Draw existing and required addition on reverse side) hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin . .ounty 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 is to become subject to Workman's Compensation laws of California." Signed --------- ------------- ----------- ...... Owner Y ---- -•--- •---- •. ------•----------•-•------.. Title (If other than owner) F02 DEPA TMENT USE ONLY APPLICATION ACCEPTED BY DATE ../ n--.-.- - O- --------------- tUIIDING PERMIT ISSUED . ............ --� -------------- .DATE . ADDITIONAL COMMENTS .................. -----•-- ---- •.............................................. ....... ........................ ................. Final Inspection by: ...... .----_ . Date . , -•-.--.•-�- - 13 2L 1-6h ficv. ec 7 '� ....._...._.. SAN JOAQUIN LOCAL HEALTH DISTRICT e/7lt 30