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FOR OFFICE USE: APPLICATION_ POEM SANITATION PERMIT -------•-------- � ��_<-�� ---------•--------------- -------- {Complete in Triplicate) Permit No: . Date Issued -14-j ----- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: 7/Jr- JOB ADDRESS/LOCAA .--/_t/_mv/��` P4 ----- G'�/ CENSUS TRACT --•---- 9------- f� - Owner's Name - --- -7?111e--------- P- ---- �d ---------------------------------`-- -------Phone - l Address ---A�2-1- ----- 6---- d �f� / . City `- / -----.License #,`, ZZa?y _-- Phone -- --- -- Contractor's Name - =- i C ` -- Installation will serve: ResidenceA'Apartment House[I Commercial[ITrailer Court l❑ Motel ❑ Other -------------------------------------------- .1 �r Number of living units:------------ Number of bedrooms .--/-----Garbage Grinder -[1!_Q__ Lot Size - ----- ------ Water Supply: Public System and name ------_----_-- - '- -- --- -W --- -------------_. _-- - nva .❑ - -P . . to Character of soil to a depth of 3 feet: Sandi Silt{] Clay Peat❑ Sandy Loom ❑ Clay Loam ❑ i Hardpan E] Adobe ❑ Fill Material _4----- If yes, type __________________________ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or se a pit permi d if public sewer is available within 200 feet,) Liquid Depth --_ PACKAGE TREATMENT f I SEPTK ,,T.ANK Size-- ------------------------- -- --- q p -- Capacity -a-�----------- Type -------------------f tenial--- ------ No. Compartment ------ --------------- ,_1 --------=---- le- Distance to nearest: Well ----- _____________ undation ---- a-------- Prop. Line ___,�________._ LEACHING LINE [ ] No., of Lines _----f--- Length of Eine__ __�,v Length __� _ ______________ - - ---- Len ----- ---- - Total 'D' Box --,/------- Type Filter Materi. Dep ilter Material ------- - ----------------------- ------ Distance to nearest: Well ___ :'-- `_________ Foundation __.__ ___ ___________ Property Line _____.______--.-__-_-__- SEEPAGE PIT [ j Depth -------------------- meter ________________ Number ----------------------- --- Rock Filled Yes ❑ No 3❑ Water Table Depth ---------------------------------------=- ------Rock Size ----------------- -------------- Distance to nearest. Well ----------------------------- ---.--Foundation "------------------- Prop. Line --------. ------------ REPAIRfADDITION(Prev. Sanitation Permit# --------------------------------------------- Date _____.'-----------..--------------} Septic Tank (Specify Requirements) ---- -----`TAN-K-- ----�l1PT�(j_L -- __ ------- aQ_6-'-m-g-C— l Disposal Field (Specify Requirements) P +GFA1 -______ EP'T -__ 1� K - ,_. _�_�_ -_. �Ks _______ C� r/ _ ---- H-----W-N�--`d ---------f_ D1>---------NO---------Or _______________ V�_�lo'� �� r� 1-KA-0011-KA-001 �I�'� {Draw existing and required ad- � ------ --------------------------------- F ---- - --- - - ---- - -- --- - ------------------------- -' dition on reverse side)_. E I hereby certify that I have prepared this_application and that the work will be done in accordance with Son Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies tete following: "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." Sign--e--d-&--,---- -- - -----------------------�-- -- Owner C -- Title ---------------- jlf other than owns FOR .DEPARTMENT USE ONLY I -7 APPLICATION ACCEPTED BY ------t-1- ' - -------------------------- ------------------------------ ----------- DATE -- [= / --- " BUILDINGPERMIT ISSUED ---------------------------------------------------------------------------------------------------------DATE ------------------------------------------ ADDITIONALCOMMENTS _ -------------- ---------- ------------------------- -------------------------------------------------- ----------------------------------------------------- -- ----- -- - `------------------ -------------------- ------------------------------- - -- - --------------- r ----- t� -- ------- - ---- --- - - - ---- ----- - A.; Finallnspectior>� ! ;- t - - Date T SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M