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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT �b- j Permit No. ._ --- lComplete in Triplicate- - r -------_--_ - r ':� Date Issued ._.!-�-�-1�-� ------------- - ------------- -------------- This Permit Expires 1 Year From . ate Issue e work Application is hereby made to the San Joaquin LoecaNkHleaCtouDytOrclnance4No 549 and existing Rulesrict for J 1permit to construct and talndhRegulatons: s pp application is made in compliance described. This app - T{ N ..._CONSUS TRACT _.__-�-� JOB ADDRESS/LOCA / 11-Phone a r V .�}- --------- 1 �-------, Owner's Name Ci't,Y ----------- - -------------------- ------------- V�1 It._l _ _------- { Address -._-- r Uense #25'4..]* Phone Contractor's Name Installation will serve: Residence partmenCH0use❑ Commercial ❑Trailer Cour# ❑ „ - `1 Motel []other --- -- -Garbage Gnndery� .- Lot Size ---------------- Number of living units:.-� ---- Number of bedrooms __ �a private ®/ --------- Wafter Supply: Public System and n+me -----------------------------ii F Clay Loam:0 t Pedt❑ Sandy Loam O Character of soil to a depth of 3 feet: Sand [�Silt❑ 3C�ay ❑ i; Fi11 Material i y e=' ----- --------- - Hardpan j� Adobe ❑ I - 'if 'es, tYP, . I i ;�, ' {n size of lot, location of system in 'relation to wells, ;puildings, etc. must be placed on reverse side.) (Plot plan, showing p p ; rmitted '+f public sewer is available within 200 feet, ��i J1 NEW INSTALLATION: (No septic tank or see a e pit P Size:_ -f --- --------- [ Liquid Depth _-_-Y- •-= ..- I . Capacity`' / /��7 Type C `T Material- MC—_jT No. t�Compartments PACKAGE TREATMENT [ I SEPTIC TAMC r ! -'�.� "t=r` Foundafio`n�_ t,- - pro Lined �. l � :.- Prop. r Distance to nearest: Well -_-_._-----�- � .rr �,. � LEACHING LINE [� No. of Lines _--_; --- Length of each line'----v_;; --------- Total Length------. I ----•--- D.' Box ,/ '� Type Filter Material _ Q'�_KFI epth Filter Material ---1- - r lit r t-------- Property Line _ �_- ._ n Distance to-,nearest: Wel! -- ------- Foundn Rock Filled Yes ❑ No ❑ �-�: } -_ Numbec...�--------=------ SEEPIT [ 1 Depth ---------------` Diameter ------------ t f. g ---Roc Size ------------------------ Water Table Depth - ti Foundation _ Prop. Line -------- ------------- 'to to nearest: Well________________________ ------------ I / D�te - -- -------------•---=----°--) REPAIR/ADDITION{Pre v-Sanitatiorl-4rmitt�#„" '"'"`ti-------- - fi --------------- / � \------------------------------------------------------------ ----- --- Septic Tank (Specify Requirements) _---=--- - � I ' Giremen#s) ------ - ------ -------- Disposal ----- e p [ 'ZJ 1 �-=.�1Jf dos+` z1jyCl rs �1 _I Dis osal Field (Specify Req - -_-----_1----------------------- ------------------------ ------ ' ---------------------------------------- --- - ------------------------------ I \ h _ -- -- -- --------------= z =�,.�. --....-„ T[Draw existing and required addition on reverse side) _.. " /� 1 hereby certify that 1 have prepared this application and that the work will be dame in accordance with San Joaquin r County Ordinances, 5t�te taws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature Zertifies the following: arson in such manner "I certify that in thperformance of the work for which this permit is issued, I shall not employ any p as to become su1ect to Workman's Comp ensation laws of California." Owner Signed -------------------------=------------------ --------- -------- �] r�.y . Title ---- ------- lif other than ow rl I l , FOR DEPARTMENT USE ONLY DATE --- -- ------ ------------------ APPLICATION ---------- �:�.- ~=` - -m— `.�------- APPLICATION ACCEPTED BY _.____- �- __�_ _ ._....----- _ 13U1LD1NG-PERMIT-ISS[1ED -- -,----._--------------------------. -=---------�-- -�--------•-- --�- -C-�- =-----°_=--�-----•-- --------------------=------------ -------------. ADDITIONAL COMMENTS _---- --- ------ f� . \_�=- -- ------------------------------- -- ------ - ---------- ._ — - ---- ----------- --- ------------- -------- --------------- �,r� Date Final lnspe ��°'� SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.