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FOR OFFICE USE: -- APPLICATION POR SANITATION PERMIT lComPlete In Triplicate! Permit No. .............. 1. ........... ... . ............ _.....•..•-••...... This Permit Expires 1 Year From Datofssued �� Date issued _la--�3 7s' 4 � r Application is hereby made to the San_Joaquin Local Health District for a permit to construct ands. lit talE the work herein described. This application is made in co`rnpli ce with Count Ordinance No. 5:49 and existing Rules.and4egufations: JOB ADDRESS/LOCATION . .. _. ...... ........CENSUS TRACT ...... Owner's Name _.. .......... ..... ....Phone ' Address .... ---•-- -- � ......-•--- ......I City e��f antractor's Name " ---...... --••................... .................... ...`.�-• . _ License " Phone . �-�, � ..... Installation will serve: Residence 0 Apartment House Commercial �'j�. ter" []Traller Court J Motel ❑Other.._...-- i I Number of living units_____________ Number of bedrooms ..__`/.....Garbage Grinder ........a... Lot Size _. ...--.--•.. Water Supply: � ....... PP Y Public System and name .. -_ l ..._.............Peat E7 ............. ......:....Private y..........a_....Clay Loam � Character of soil#o a depth of 3 feet: Sand�] 5ilfi❑ Cloy [] Sand Loam � . Hardpan 0 Adobe Fill Material if yes,type � +$x, ` { --•---•.... ..............: .....__._ (Plot plan, showing siie of lot, location of system In relation to wells, buildings, etc. m atbe placed on reverse I NEW INSTALLATION: side.) •(No septic tank or seepage pit permitted if public sewer is avail b e aVit4 n 2001.feet,) PACKAGE TREATMENT [ ] SEPTIC TANK i G ze- -� .11-......... -•--- 4Liqul�E Depth ... Capacity/!SM- '_..----- Type ;-• Material. No. Compart .. i5 ^ I �� menta Distance to nearest. Well Foundation �_Q.. ..-•- • 1 ,� ----•---•--•-------•-•-•-........__ .. Prop. line . _ LEACHING EINE I No. a"Lines Len ' .. . Length o ea line_. ._. .. .......... Total Lengtht._l D' Box ,. I :.. V TYPe Filter Material - ------- er Material k l ) J ,...,,... .. .�'... .......-J.,.......... Distance to nearest: Well .__.._ ...__..._,- Foundat�np l ig } Pro a i-•. .. I T De th Filt SEEPAGE PIT Depth ,� : /{ - ed .... p rty Llne -----�.� , ''-� Diameter _ Number!..___- 11I_ Rock Fill Yes I o Water Table Depth --•---•-- Rock Size3. ._.. . .� -.. ................... ..- L. . V Dist ars L : Well ..• --••...................Foundation ``1Q =f 6 Prop ine REPAIR/ADDITION IPrev. Sanitation Pe.rmIt � .. If' � --••----•--••-•--•-----••.-----•---•- - Date 1 Septic Tank (Specify Requirements) I¢_� J ...................................... Disposal Field (Specify Requireinents)�.............. . -••----.....••• •--•-•-• ----- . ...... i ............... f � .:.... -- - -------------------------------------------•- - ...•• ---•. - .... (Draw existing and required addition on reverse side) I hereby certify that 1 have prepared this application and that the work will :be done In accordance with Sain _Joaquin County Ordinances, Stag Laws, and Rules and Regulat€ons of the San Joaquin Local Health,District. Homo owner or licen- I sed agents signature certifies tie following: "I certify that in the performance of the work for which thisp01 It is Issued, I shall not employ an ' i as to become subject jo Workman's Compensation laws of,California:" y persenin such manner Signed :+#_- --------- f - - ...,. Owner- . .... BY --------- --- - -- ---' Other t an nerl -'-----------t----•------ ._- Title --- (if � � � --- -- ------------------------------------------------- FOR ---------------- -----------------------------FOR DEPARTMENT U ONLY APPLICATION ACCEPTED B w .. BUILDING PERMIT ISSUED _'._... ..._.._... .._.. DATE -./�.2:7,_1-.,7j _ ---... ADDITIONAL COMMENTS ..... - ------ DATE ....... --•-- -------------•--------•- --.._._. ------ ------ ------------------------------ ----- •- ---- -• -.: - Final Inspection EH 1� 2a 6 _ ►.._ i ` "'� c% ✓ :_._Dare ...._...... �` ` SAN JOAQUIN LOCAL HEALTH STRICT 7h }M