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FOR OFFICE USE: _ ^ APPLICATION ,FOR SANITATION PERMIT k (Complete in Triplicate) Permit No: ----- - ------ This Permit Expires 1 Year From bate Issued Date Issued Application is hereby ^d J al r permit to construct and install the work herein described. This app, a, ri s 1 p N U 549 and e Wing Rules aanndRegulations: 5 UN LATi 11tc�tpx JOB ADDRESS/LOCATI N /67_��-4/o------I = � 0 S�Q/ _CENSUS TRACT ' Owner's Name -.- __ - - °t �1 -1-� Phone Address -�11 t_------./,7-I ------------------ --.--. city !t'!/�frl/ Contractor's Name ---/ $h y� / I /v /f//t/S------.License #pSJp --- Phone Installation will serve: Residence Ug-Apartment House❑ Commercial':❑Trailer Court ;❑ Motel ❑Other ��" Number of living units:____--.__ Number of bedrooms __3------Garbage Grinder --/VD--- Lot Size _' ---------------------------------- Water _ _-___--___Water Supply: Public System and name _______________________ F _Private P-1 d - --------------------------- - Character of soil to a depth of 3 feet: Sand'g2ol* Silt❑ Clay ❑ - Peat❑ Sandy Loam ❑ Clay Loam,0 t - � ! r_ - -.1,Hardpan E] Adobe'❑-.Fill MateriaL.l------ If.yes;type ------------------------- d _ 7, T (PI'ot plan, showing size of lot, location of system in relation to wells, Buildings, etc. must be placed on reverse side.) NEW INSTALLATION:. (Nosep itlt c tank orr`seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ -SEPT. TANK `, �/ � Capacity ICQIT - x � Size__5-y� -_ 4-�----------------- Liquid Depth --- _6_Z----------- " P Y E10 ------ Type��r–_P_r3 Material_&'9.4±le— No. Compartments __ --------_...... once Lto nearest: Well ----�-------------- - ---__---Foundation ---40------------ Prop. Line ------5__•--------.-- p - LEACHING LINT: No. of Linesl _t___ _______________ Length of each line---7) - ----- Total Length I V"._ Type Filter Materialp e--------Depth Filter Material ------ --------------- /Q Distance, to nearest: Well ___ ____-----_-- Foundation __ _________._- - Property Line. ___5.---------_ - SEEPAGE PIT [ ] ) Depth ._------- _ Diameter --------------- Number ----------------------- _ -- Rock Filled Yes No, # } ❑ ❑ t Water Table Depth ------------------------------------------------Rock Size ------ Distance Jo nearest: Well ----- __ p ------------Foundation -------------------- Pro Line ......................REPAIR/ADDITION(Prev. Sanitation Permit# -------------- ---------------------------------_____ Date ----------- Septic Tank (Specify RequiremenfsY ---------------- ------------------------------------------ - Disposal Field (Specify Requiee`ments) -------------------------------------------------- -----------------------------------1---- ------------- y ' _______________________________________________________________ w -- P Y ----------------- %e ------------------ -------------------------------- --------------- --------------------------------------- (Draxisting and required addition on reverse-side) — - _� I I hereby certify that I have re ares! 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. Nome owner or licen- sed agents signature certifies the 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 beco a subject to Workman' Compensti.on laws of California." Signed A0I .� ...,. - ----- ---- ------ ----------- ------------ ------------------------- Owner� .."...r.- .�_.�..,.. BY I _ _ 're----- _ -�QCs-- (If other than ow r) I- Title .._____ FOR .DEPARTMENT US ONLY IPPLICATION ACCEPTED BY ._______�_-_-, 1-- - !WBUILDING PERMIT ISSUED - _.~ DATE -~-C---4Q-r_ ---------- ) : ---------------------- --------'------ -------DATE -------------------------------- .--- -- DDI710NAL COMMENTS _ - --- :-------------------------------------•--------- ----------------------------------- . -- ----------------------------------- ----- ----- --- ---- - - -------- -------------- ------------- -------------- --- - -------------------- ------ ------------- -- -- --- - -- --- --------------- ------------------------------------- - --- - --- - ------------- ----- ---------------------------------------------------------------------------------------------------- Final ]nsp - - -- --- --- --- - -- --- ----- - - ------------ - ---- - -----Date ---- _ SAN JOAQUIN LOCAL HEALTH DISTRICT ) E. H. 9 1-'68 Rev. 5M, r