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FOR OFFICE US • APPkJCATI N FOR SANITATION PERMIt .� Permit No- -------------- -- (Complete in Triplicate) Date Issued -----' ----- --- - --- --- - his Per` This Expires 1 Year From Date Issued Q-71 r` ( 1o�.aS .._._..- -------------- ---- --• yF: o the San Joaquin Local Health to construct and Install the wor Application is hereby made th District for a per k herein described. This application is made ih compliance with County Ordinance No. 549 and existing Rules and Regulations: 5`�OB +ADDRESS/LOCA ION ------ -- � _�PC'('RS-__,. �.1�` -�SI�It------- ----CENSUS TRACT - ------------•----------- �_-. Phone - rOg6- ► - Owner's Name -_ h�-�-� �--..-.--- = -- ---- -------a------•------ q — - - city -- �-�1c_�-- ---------------------------------------------- ------------- ------ -- - - - Address ---- ------- 1, �----- 1 .--. �-�;' - __�C7. ` _ _ s1�-''-------------------------------license# _�-1 -,- b�----- Phone ---- , Contractor's Name ----- 1 !- Installation will serve: _ _ Residence❑Apartment House❑ Commercial[ frailer,Court Motel [ Other ------------------------------------ -- •-- • Garbage Grinder - ----- ---- Lot Size ---••----------- als C - ---•-- Number of living units:_-- Number of bedrooms _-----.---- Weer S;-j4-_V M private ❑ l Public System and name - � � ��'�---- �--- ----------- - Water Supply- t❑Silt Cly ,{] Clay Loam Peat Sandy Load Cl - Character of soil to a depth of 3 feet: Sand F] a -- Hardpan ❑ Adobe Fill Material ------ ---- 1 yes,type F n showing size of lot, location of system in relation to wells, buildings, etc must be,pieced on reverse side.) ;Piot plan, 9 it permitted if public sewer is available within 200 feet, NEW INSTALLATION: (No septic tank or,seepage p' P SEPTIC TANK Size [C3>CSX ---- .---- Liquid Depth ------:------------•----- PACKAGE TREATMENT [ ] I - _ - Mcsterial.l" -_ b Na Compartments __-_ Capacity� 69 -_ Type -------------------- �. i 1. ---------------Foundation _�0_!. ---- .Prop. Line --`------------ .._1 r Distance to nearest: Well _O�"-t - ; Length of each line �� - Tota! •Length ------ -CO------------- S LEACHING LINE No. of tines _ - L, IJ T Filter Material *- -Depth Filter Material -----_1D--------- - - - - - D' Box _- ------ Type ©/ Property Line --�- � .-- Foundation - ------------ Distance to nearest: Wet! -a� -_- ---- No�[) SEEPAGE PIT [ ) Depth --------- ------- Diameter --------------• Number -------------------- Rock Filled Yes ❑ L _ -•--- -------Rock Size -------------------------------- Water -----=--------•--------- - "- Water Table Depth ---- ---------------------------- � + - -Foundation --- c'r'op- Line•'=--------- — Distance to nearest: Well ----------------- •--- - �.�,� �t �... Date ------ ---------------- REPAIR/ADDITION[Prev. Sanitation Permit ---------------- Z rS Septic Tank (Specify Requirements) ------------------------------------ '- - I: --------=--------------- Disposal Field (Specify Requirements) ------------------ - - - - -- ----------�--------- -------------------- - - ------- - `,4 ,� - ;Draw existing and required addition on reverse si e 1 hereby certify that 1 have prepared this application and that the work will be done in accordann' wrth San Joaquin County Ordinances, State Laws, and Rules and Regvlatiotss of the San Joaquin Local Health Dishitx c`tlHonte-o+vvrra' or licen- sed agents signature certifies the followingsin such rrrartaer "I certify that in the performance of the work far which this permit is issued, 1 shall not employ anyperson. as to become subject to Workman's Compensafion laws of California." - Signed ----------------- - -------------------- Owner. _ - - 7itle BY "- ----- -------------- (If other than owner) POR DEPARTMENT USE O 'DATE ------ --------- --- - APPLICATION ACCEPTED BY _ - -""" " ----- - DATE ------------------------------ ------------ uz— BUILDING PERMIT ISSUED --------------------------------------- ----- -ADDITI N L COMMENT _ ----- --- ------ ----- - --- ------ • --- -- -------------- ---------------------- rr - ----------------- Fina nspect+on -------------- SAN- - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1268 Rev. 5M