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' •FOR OFFICE USE: - R APPLICATION FOR SANITATION PERMIT permit No. -.7�`�`•�•- ' •�•.••--- - • ., _ (Complete In Triplicate) I Date Issued fA• � � ... t This Permit Expires I Year From Date issued -------•---._. �= • ..................................... °)*, . 1 e work herein Application is hereby made i sd San Joaquin mos in compliant with County c tOrdinance and for a Ner o. 549 and ex sting Rulesinsmit to construct talndt Regulations: described. This application .f� / - ................ Phone _ .....-- ....... CENSUS TRACT JOB ADDRESS/LOCATION ......- ,. , ._ � i M k f....................r•_....._ .. ..._........... Owner's Name __C. _ ��.lf.%_'.F"E�• •.....................;� ��:' ._. Address _..-..� 4�..� '..... - . City f ...._. '-` License # / �� Phone..i.'- .fes Contractor's Name ........ 16` . .. _ s Installation will serve: Residence Apartment House 0 Commercial []Trailer Court ] .. A .. NumberMotel ❑Other ---------- '...... ' . f [ GarbagePGrinder -�__ Lot Size ............1 � Number of living units:............ of bedrooms . -• . F 1 vats Water Supply: Public System and name ...:. �_,•-----•.:_._..._. =* PLClay Loam Character of soil to a depth of 3 feet: Sand Sift❑ Clay Qeat❑ Sand Y' ;oam ❑ I -- Hardpan ❑......•Adobe^Fi11 Material ............ If Yk type I �' {Plot plan, showing size of lot,rlocation of,system�in rela#ion to wails, buildings; etc. must be placed on reverse side.) NEW INSTALLATION: "{lVo septic tank or seepage pit permitted if public sewer is available within feet} i F s- f f.! � i _., � Sias ,�f. -t,'��...--------•-- Liquid Depth '..................� PACKAGE TREATMENT [ 7 SEPTIC;ANKYj . t - _ a . No. Compartments ....._. Capacity��-•--• TYp�•V - ••-.... Materiai �l Pr _..._... O ... o Line,C • Distance/to nearest: Wel -=---• Founda#ion .,/l�...--- -• P Il , i LEACHING LINE ) No. of Lines ..._._ ___... Length of each line.._ ............... Total Length` _ -- __...._.._.. 1 VBox j. f-3--".- Type Filter Material,. •Depth Filter INateriai� .- 1.t �r / Property Lige _`" .. Foundation �� . P �Y -� f Distance to nearest: Well _. _..as__. ` -� __. Diameter ..--•- Number ....... .............. Rock Filled Yes,�$ Na [1� SEEPAGE PIT �(j Depth t 101-- - -- r; sem`. .............Rock Size/-.-- Water Tale Depth __--- --�•--.....�--•---•- ,a .1 ;S �y ...................Foundation ..;! _...... Prop. Line ._ tb Distance to nearest: Wefl . ,� •••----• 't A' ...... ---- Date ................................... REPAIR/ADDITION Prev. Sanitation Permit# ------••-•••- Septic'Tank (Specify Requirements) ..................................................... Disposal Field (Specify Requirements) ........................ -------------------------- ---------- -----••--------•------------------•--- i -- •............. ----- --------•---------- ---------•-- _..------... _ _ ______... ............................................................ _________________________ ___________ .......................................................... . t (Draw existing and required addition on reverse side I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws,1and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature'certifies the following: erson in such manner 111 certify that in the performance of the work for which this permit is issued, 1 shall not employ any p as to become subject to Workman's Compensation laws of California.` Signed --- ------------ - --- - -- -- ............ ......................... - Owner Title 06� .............................. BY • ......... other than owner) FOR DEPARTMENT USE ONLY W DATE .... C�- 1'1-n3................ APPLICATION ACCEPTED BY .. -- ------------------------------------------ .......... --- -------- --------------••-...---- • BUILDING PERMIT ISSUED ... ... .... ::............. ......................................................... DATE ADDITIONAL COMMENTS .•.......................................... :........ . . ----------•-------_--••--.. ......................................................t _. _....._..._.-.._.....................__...__••_•--__..._...._.............._.............._....._. .... .._....-...___•• - -il ..................................................:.F....... ........_....-..__...._-_..._........_........_.............. .............. ...... •_-... .. ..:_ . .•...................••-- Date _ _......-............ -••---....-----• Final Ins action b . ...............................••--•-------• l.e. {� - SAN.JOAC? IN LOCAL' HEALTH DISTRICT 7/723,M