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FOR 01=DICE.USE: �.� APPLICATION POR'SANITATION PERMIT r/ Permit No. (Complete in Triplicate) C ---------= --------------------------------------- Date Issued "-_1 p. �- --------------� This Permit Expires 1 Year From Date 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 �o_unt rdinance No. 549 and existing Rules and Regulations: rn o)Cr'V4W 7793 Lia S/5AF 0i`/ffv?Z JOB ADDRESS/LOCATIONc� q�.�'- -_ CENSUS TRACT --- " --� ---------------------- Phone ------ Owner's Name ��►.--�--- _��'e��--f__._------ - ------------------------------------- Address / -------------------------- ------`-l--R----�---- ---- --------------------- -- ----.License I PhoneCantractor's NameY --------------------------------------------------- Installation - Installation - -T will serve- Residence ❑Apartment House❑ Commercial :❑Trailer Court ❑ Motel ❑Other Number of living units:---!.------ Number of bedrooms g� 'J --------- Number Garba e Grander/"_ -- Lot Size ---- _.- r Water Supply: Public System and name -------------------------------•--------------- -------------------------------------- !------------------ Private ❑!� Character of soil to a depth of 3 feet: Sand' ;It❑ Clay ❑ !Peat ❑ Sandy Loam 'LTJ Clay Loam,❑ -Hardpan ❑ ;t Adobe'd Fill Material -------- If yes, type __------------------------- (Plot plan, showing size of lot, locafion of system in relation to wells, buildings, etc. must be placed on reverse side.) p NEW INSTALLATION: (No septic tank or - p seepage pit permitted if public ewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK'[ Size ------------ "-"/1--`' ---------- -------" Liquid Depth ------------ Ca p a c i ----------Capaci#y G�"Q, � TypeAFW_---_- MaterialGWA:�4.1_'Z_ No. Compartments S;�^---------------- 6**) Distance to- nearest: Well.— - ---____--------------�Foundataon,, �---------_-___ Prop. L ............ LEACHING LINE [� No. of Li�'es'l-------/----------� LL ngth of ect Q-line---a- ---------- --- Total Length y-f-----•-•-.-.-.-- 'D' Box --- Type Filter Wterial/��-k--------Depth filter Material ��--;------------------- •-------•- Distance tof o nearest: We11 -F- --___f-----_-" �bundation f4----___-'-_---- Property Lir1� Q------------------ SEEPAGE PIT [ ] Depth --------n,_�=---;Diameter I --- ----------- Number .--------------------------- Rock filled Yes 0 NO :0 Water Toble'jssbppth1 -------- ;-Z L l ..-g--------------------•--------Rrock Size ---------------------_ -------� - Distance to nearest: Well oundation Prop. ane . REPAIR/ADDITIQN{Prey: San;tation Permit# _-------'---- F Date', ---------- --- ---------- --) �,isepti. Tank (Spec#y Requ men s) ---------------- a -------------------- -------------------------------- -------- - ---------- ,. ire t Disposal'Fi'el'd; (Specify§'Requirements) --------------------------- --------------------------------------------- I VS T€,! _ �.� r } -- -i � -------- i - ►� J� "aC�tai Cf f -- f"t r i q4!t `----- - - f _? � '------------- ------- �' = u= " -.. 7y� ) (-Draw existing and'required addition on reverse side) t L 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 "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 subject to Workman's Compensation laws-of.California." i Signed - Owner " TitleC7"TiP �`` X-•F � -------------- BY ---------- ----------- (If other (an owner) j FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --------7_t_Rt_a------------------------------------ ----------------------------- DATE -----e�_-µ �.�----------- - ------------------------------- BUILDING-PERMIT ISSUE-D --==�-----~--- mn---- ---- ADDITIONAL COMMENTS . ``• ='-------- .?" ": ,r'_ '----- ` - "'� ': ' `.: y------------------------ ------------------------ ------------- , . , - - ---- ---- - ----------------------- - ------ - - ---------------------------------------------------------- ----------------------------------------------- - ---- ---- --- --- - - r -- - - Final Inspection b - -- ate Z� f SAN JOAQUIN LOCAL. HEALTH DISTRICT E. H. 9 1-'6$ Rev. 5M