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FOR OFFICE USE: - APPLICATION ICOR SANITATION PERMIT r 4/ ................................-•...................... Permit No. . �sd1 .. _ (Complete in.Triplicate) . , .......... Hate-Issued ...1-T ..7� C- _•••..........•...........:....:.:. This Permit Expires I Year from D.ah lit" d �. ......... Application is`hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein =` :described. This { ication is ade1in compliance with County Ordinance No. 549 and existing Rules and Regulations: 2 9 7 y 2ap� . ... . _.. .. N4 �`G Q.�. ..,� ... JOB ADDRE§S/LOCAT N .• r` / 1• ,Cir TRACT ..--•----•------- ---•--. sus Owner Na e - :._.:. ............:......:....:..... .... Phone c�. Address _ .�-�t�_ F 1...... ... . . ....:City Contractor's Name Lxl1¢_._r� ,�L � :. sh....Lioense # --- Phone ° - Installation will serve: Residence p Apartment House] Commercial CITraller Opw Motel ❑Other...--- .................................. Number of livingunits:.....� Number of drooms ., ......Garbs a Grinder lot Size .....------ - Water Supply: Public System and risme ......._..,....�...................................... ..Private ' -- --- - Character of soil to a depth of 3 feet: Sand El Silt 0 Clay 0 ., Peat Q Sandy loam ik Clay loam 0 Hardpan p Adobe 0 Fill Material ............ If yes;type {Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be planed on reverse sl e. NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,} Li uid De ..... ................ PACKAGE TREATMENT f ] SEPTIC TANK Size.0.�Jv .............. ...•-• q Pd► Type ap- f CapocitylVt T _ p rT ��G�4 `�.t. Material--- No. Com artments ..------•---�._..._.. i r -` Distance to nearest: Well _ .:.......................Foundation ... ._._._...._..--- Prop. Line _.!,- -----...j..-•--•, lr� LEACHING LINE No. of lines - r ....... •-:_ length of each line-., ... $ __ To#al Length ._.�.. ................. 'D' Box Type Filter Material _00f; -Depth filter Material ..- .f r . .......... •-_... Distance to nearest: Well .. ---_•••---.... Foundation -la-.r..------.. Property Line .... .................. ... "P1 S66PAO T {X " Depth ..10........... Viameter 1 t� Number ............. ........... Rock F€fled Yea � No �k m . ............Rock Size .._: r f Water Table Depth -----.-.-[�'...��.................... ._�.__.r_...--•----•• �`.r I Distance to nearest: Well -- •_ 1:.........Foundation ..� ........... Prop. Line ..................... C�REPAIR/ADDITION(Prev. Sanitation Permit 5l& ..-•-. Date ...........-•............. ....... -5 C - 5eptit Tank (Specify Requirements} .......................s:..............:..............:............................,................................._.__ .................. 9 Disposal Field (Speci#y Requirements) ...........................................-.------••---........ .----•----...:.........-•--------•--- --..--..._•----------•�_� 1 .........--- ---------------y-------------------•---...--------"----------------........... ......................... {Draw existing and required addition on reverse side} I herebycertify that i have prepared this application and that the work will be done in accordance with San Joaquin fY p P County Ordinances, State Laws, and Rales and Regulations of the San Joaquin Local HeaIth:Dlstrict. Homeowner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit Is issued, l shalt not employ any person in such manner 4 as to become subject to Workman's Compensation,laws of California." :Signed ..... °: ----- --- --- -----------•............... w _ Owner �— i' 1447 - ........ Title -• (if other than owner) f9RPEPARTWNT USE' ONLY APPLICATION ACCEPTED BY - - --- - ---- -- c -�p .....DATE --.•--•----- ... :BUILDING PERMIT ISSUED -•--------•-- -------_--------- ......... ---..-_- -...............:........ ._ ADDITIONALCOMMENTS --------------------------------- ------------------------------------------------ -------------------- --- •-------•- •---------------- -------------- -.---.----------•---•--------•----•-------..------•-•--------••OkI7� . ...--....-•-•-•--................. k .. ...-- .--•-.------•- -----•-----------------•----------•---------------- -- Final Inspection by: ----- .... � .....................................:.--..................Dae = � •_...--..........-- ESI: 13 21.E 1--613 Re SAKI JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M