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FOR OFFICE USC APPLICATION 00k SANITATION PERMIT N �, ---------------------------------- Permit No. ----- ----------------- - {Complete in Triplicate} � / > - ------------------- ----------------- - - Date Issued . This Permit Expires 1 Year From bate Issued 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 No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION _.talo b - M0,A0,t CENSUS TRACT Owner's Name ----------------------- ---------------------Phone.3+n----Q�`l ----- - Address ---VV(.IAA--hs , - O----- -- -----. City hroi----------------------------------------------- -------- Contractors Name .-�- � ----1 - -�_ d- -------------------------------- License # ------ - ------------- Phoned - �{2S I----- Installation will serve: .—Re`sidence'❑Apartment House❑ Commercial [railer Court J Motel ❑Other 9 l r Number of living units:.0... Number ofgbedroorns 000----- Grinder -W�)----- Lot Size ----------------------- �� Water Supply: Public System and name _ �h �1 ------ ----------------------- - ) , Character of soil to a depth of 3 feet: Sand'❑ 'Silt j] Clay ❑ Peat ❑ Sandy Loam" Clay Loam Hardpan ❑ Adobe.0 Fill Material -------- If yes, type ___-______________________ i (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pitpermitted if,public sewer is available within 200 feet,) e 18 ©�U- T :yet t --------- Liquid Depth PACKAGE TREATMENT SEPTIC TANK Size_ _ _ ______ _____ .^.. _____._. q/ _ . \. , x,:1.3 ,p Capacity --_s. _ , ] yp` ��D---- Materials_ �[]_� No. Compartments _*_:3---.-•----- 11 Distance to nearest: Well _._�?Q7_____- ------------Foundation CzO__-----____ Prop. Line _____________-------.- �. LEACHING LINE [ ] No. of Lines - -------- ------ Length of each line----------------------- ---- Total Length ---------------------------- 'D' Box --------- -- Type f=ilter Material - --�- ------------Depth Filter�Materiai ---------------------------------- N Distance to nearest: Wel! — ________ _____�Foundation _---. i__._____-__ Property Line ___.______-_.-----.:-.-- i SEEPAGE P17 Depth Diameter ___.,__-_--_____ Number _.______.__---------------- Rock Filled Yes ❑ No i❑Z [ ] p ---------------- Water Table Depth ---------------------------------I_----�..-----Rock Size -------------------------------- Distance to nearest: Well ------------------------ ---------------Foundation -------- ---- Prop. Line ----------.-.-.------- REPAIR/ADD.ITION(Prev. Sanitation Permit S# --------;--------------------------------- Date ----------------------------------} Septic Tank (Specify,Requirements) ----------- '---- - ----------------------------------------------------- --------- ---------- Disposal Field (Specify Requirements) ---------------------------------------------------------------- ----------- ------------------------------- ---------------------- -------------------------------------------------------------------------------------------------------- --------------------------------------------------- - - -------------------------------------------=---------------------------------------------------------------------------------- (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 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 as to become blect to Wo man's Compensation laws of California." Signed ¢ --Z.. - -- Owner ---'_ -------------- Title ------------------------------------------------------------------ j (If other than owner) l FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY - ------ -- - - ------------ ---------------------------------------------------------- --------. DATET= _-�------------------•- BUILDINGPERMIT ISSUED ------------------------------------------------------------------------------------DATE ------------------------------------------- ADDfTIONAL COMMENTS -_ A-0--- - -- -- -- ----- ----- -- - -- - ----------------------------------------------------------------------- --- ------------------------------------------------------------------------------ ------------------------------------------------- ------------------------------------------------------------ --- ---- ------------- - - ------- --------- ------------------- -------- Date -------------------Final Inspection by: ------- -------------- ------------------ -------- -- is SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M