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DATE F.3 <br />inal Inspection by: . . ••44• 4 44 •$n . 4••4 ..... 444 • 44 • <br /> Date <br />R DEPARTMENT USE ONLY <br />APPLICATION ACCEPTED BY <br />BUILDING PERMIT ISSUED <br />ADaTIONAL COMMENTS <br />... <br />•• <br />= DATE. <br /> <br />FOR OFFICE USE: <br /> <br />2_1 -2_e <br /> <br /> <br />APPLICATION FOR SANITATION PERMIT <br />(Complete in Triplicate) Permit No. . <br />Date Issued 3 I -73 <br /> <br />This Permit Expires 1 Year From Date Issued <br /> <br />Application is hereby made to the San Joaquin Local Health District for a <br />described. This application is made in compliance with County Ordinance <br />JOB ADDRESS/10 .TION ‘42 <br />Owner's Name <br />Address <br />Contractor's Name Aet"IseseeAte4:e.! ... <br />Installation will serve: <br />Residence 0 Apartment House 0 Commercial ETrailer Court <br />Motel f: Other 19Irt1-1-1.Z. <br />Number of living units:...._...... Number of bedrooms ... ...)77-........Gerbage Grinder Lot Size • cv .4 .e. ..r..4...__ <br />... Water Supply: Public System and name _ ...__Private _ <br />Clay-, Loam El .. <br />(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) S.\ <br />LEACHING LINE f ? No. No. of Lines j I <br />/el; ' <br />PACKAGE TREATMENT f .] SEPTIC TANK Size Liquid Depth Lyi <br />NEW INSTALLATION! (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br />7 Length of each line F <br />. oun.sdation 'SI ' Prop Line 5 1 , <br />Capacity ..1.4 .0.D4 Type Material e-4-•%-t—e-- No. Compartments ----- <br />Distance to nearest Welt <br /> <br />, / ...iv , # s .., <br />............Total Length •g0 <br />A t <br />'D Box ..---, Type Filter Material c.5 R Depth Filter Material 79' fr ' ... 7.. .... _ r <br />..-_...5'Distance to `nearest: Well ...e6 .0. ....... ....... Foundation J ‘., Property Lint 6 <br />SEEP= [4 . . "7 Depth / 1; ' EtictrKEriF 4"/ ? / Numbe- <br /> <br />. / Rock Filled Yes No I' <br />7:5 .....,i' .3',/,' /-'. Water Table Depth Rock Size _ , <br /> <br />. . Distance to nearest: Well 3/0.0 0 <br /> <br />, _Foundation ,./..0. ... Prop. Line i <br />REPAIR/ADDITION (Prey. Sanitation Permit # Date J , <br />Septic Tank {Specify Requirements) ..... ..... <br />Disposal Field (Specify Requirements) <br /> <br />•••• • •••• <br /> <br />••• • ••••• • 40 •• • . • • • .. <br />{Draw existing and required addition on reverse side) <br />I hereby certify that I have prepared this application and that the work will be done in accordanceith San Joaquin <br />County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or !icon- <br />sod agents signature certifies the following: <br />"I certify that in the performance of the work for which this permit is issued, I shall not employ any person in seal inanmor <br />as to become subject to Workman's Compensation laws of California." <br />Signed ... Owner <br />.;*e. . Title 47,1:444...40-e.Zie <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />•ty°47,64.--1 <br />Alt—V4( City ,......e4tt-3.4.... " License # <br />permit to construct and install the work herein <br />No. 549 and existing Rules and Regulations: <br />... CENSUS TRACT S / . . .. , <br />.Phone 4444.4 , <br />. 4.44444 ....... 44•• <br />.....—Character„of,soo_a depth of 3 feet:Sgind&ILO Sandy Loam. <br />Hardpan 0 Adobe 0 Fill Material If yes, type <br />By <br />(If other than owner) <br />E. H. 9 1-'68 Rev. 5M