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FORS _. _. . .Permit No..,--�� <br /> OFFICE USE: .� � �`APPLICATIOI�FQ1� ANITATION PERMIT L <br /> (Completo in Triplicate) ! <br /> ----------------------------------------- Date Issued 477--_S17?�:• <br /> This Permit Expires l Year From Date Issued----------------------- <br /> I <br /> Application is hereby made to the San Joaquin LocalfHealth'.District for..,ar permit to construct and install the work herein <br /> described. This application is compliance mq a in liance wit County_ Ordina ce No. 549 and existi Rules and Regulations: <br /> ( P � <br /> j-- _ - ! - rr-tea 'CENSUS TRACT �I�I <br /> ------- ------------ <br /> I OB ADDRESS/.LOG ION ,[�.�.__ 5:_ �N - t <br /> e -------•------- <br /> ' - ---------- <br /> Owner's Name %'- ---= 1 . <br /> t .___Phon .- <br /> ,Address � -- -- � --------- --- 7 <br /> J <br /> Ph <br /> s r cense - one <br /> :.. t - <br /> f Contractor s Name:.--_� --'-- - : ,- - �- "v: -;- -----,�--- - ------ ------K i .//�.�97�� --------------- <br /> Installation will serve: Residence- partmenf Housedn Comr4rcial-------- <br /> -]Trailer Court ,❑ <br /> { .. ,.Other ----� ------------ -� . ------ Lo# Size 'Po 41 <br /> of living units;----- __:"'Number of bedrooms ______ ___'_Garbage Grinder <br /> Water Supply: Public System and name - ' ---------- --- --- - - <br /> ------------------- PrP <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt,❑ Clay ❑ Peat❑ Sandy,Lopm .❑ Clay Loam <br /> I Hardpan []— Adobe Fill Material -_ If yes,type -_-____________________ _ <br /> ' .(Plot plan, showing size of lot,!Iiocation of system in relation-to wells; buildings, etc. must be placed on Feverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted_if,public sewer is available within 200 feet,) r <br /> s •��` • <br /> PACKAGE TREATMENT { ] SEPTIC TANK'[ -1?-IK--- - - -------- --- - - ---- Liquidpth ` <br /> -------- Type - -, M aterial[; z+_ No. •Cor�partrnents.........•..-----••----•- 6 <br /> Capacity f�4�7 yp � '' -------- <br /> (A;-7-_z_. <br /> } •' - ----------------- <br /> Distance' <br /> L <br /> Distance to nearest: Well ----- �--------- --------Foundation :_ =,_: Pro 3 Li.rLe .- --•-•-- <br /> v <br /> __ Length of each line. -_Cs �tpry-6 --- Total Length —--------------- <br /> LEACHING LINE [ � No. of Lines -r?/.1 ------ 9 <br /> t '______De Depth Filter Material _- ��------- - - - -• <br /> �I y <br /> Box , _:..�-�.Type Filter Material_fi�"-----:-=- p •- - - ---- -•-- <br /> Distant to nearest: Well -_ _ ___ ._ -,___ Foundation _ - -------------- Property Line-��-- ----------------- <br /> - . <br /> " - <br /> "SEEPAGE PIT [ Depth __ .----.-- -- Diameter __ ____lNurriber ____._.__ _ ______-,Rock Filled, Yes No f❑ <br /> Distance oWater I nearest Wel /F Ute______,.....• - Rock Size `-Z--�- -- <br /> th ---- ----- -- - <br /> Foundation --Prop. Line <br /> I i REPAIR/ADDITION(Prev. Sanitation Permit�# ------------------------------ -Date --------- - -} <br /> - � <br /> Septic Tank (Specify Requirements) -. ---- <br /> -------- �-- --- - -------------- -------------- --------------=--,:------ -----------;-----r--- --•---------------------------- <br /> Disposal Field (Specify Requiremenfis) ------- -=-------------- <br /> f _ ti <br /> 1 ! _____________ _____----__ --i____ -.---____-_.___ <br /> S ------------ <br /> -----------------------------__ -------- ------------------------- - ---------------------------------------- <br /> (Draw existing and required addition on reverse sider" , {' <br /> I+rhereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin <br /> County Ordinances, State Laws; and Rules and,,Reguiations of the San Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the following: <br /> r "I certify that in the performance of the work for which this permit is issued, I shall not emplory any person in such manner <br /> as to become subject to Workman's Compensation laws of California." r� <br /> ' F Signed ---------------------------------- - ----------------- Owner <br /> - ` ---- ---------- <br /> BY -------- ------------------------------ -------------Gc ------------------ Title ---- --- � ? --- ----------------- <br /> (If other th wnerl <br /> FOR <br /> DEPARTMENT USE ONLY r�.� <br /> APPLICATION ACCEPTED BY ----- - - /_ ------ ----=-------------------------------------------- DATE S. --.'6`'-----•-------•--- <br /> BUILDING PERMIT ISSUED -------------------------------.-DATE -------------•----------------------- ---- <br /> ADDITIONAL COMMENTS ------------------- ' <br /> ----------------------------------- : <br /> t ------------------•-----------------=----------------- <br /> --------- ------ --- --- ----- ------------------------------------------- - <br /> `------ -- - ------ - <br /> Final Ins ection b a. -= Date -_ -� <br /> PY .� ------- ; <br /> N' <br /> SAN JOAQUIN LOCAL HEALJH DISTRICT NO <br /> r <br /> E. H. 9 1-'68 Rev. 5M 3 ` ` <br />