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»• _ �':� .!-�—`�''--.� .ate.-- �' � — - 1Y� {FOR OFFICE USE: 4APPLICATION FOR SANITATION PERMIT Permit No. .. 5 ��~ (Complete in Triplicate) Date issued .�d•• 7 This Permit Expires 1 Year From Date Issue . i all the work herein Application is hereby made to the San JaaquincaN'H� cultyt0rdinarnce No. 549 and existing Rules ermit to construct and tand Regulations.- described, egulat ons.- i described. This application is made in compliance licat JOB ADDRESS/L TION7&7 ............................ one rem. :: _�:...� Owner's Name 16►' 7.. Q_. .- � ---.....••-----•.--..... � ..............................................� Address C' ns 't � `_ _.��----- -- y �r---. Phone ..�:3�,�__'�a..� n License # r � Contractor's Name -_- Installation will serve: Residence 42'Apartment House 0 CommerciaV❑Trailer Court Motel ❑Other ........._': :_ .:..........:.. LotSize ......................••----...----•-••--... Number of bedrooms ..Jam..-:_.Garbage.Grinder....--------- . Nvmber of living units:... - A ate 21, • �- . Priv Water Supply: Public System and name ..•-------------------------- -. ....... --- --- ••- --- = - Sand Loam :.Clay Loam.-Q l.. .. - �. Silt Clay �[] ;:.Peat❑ Y, .� -��. . . Character of-soil-to a depth-of-3 feet:-=Sand o ❑ y e= E !' Hardpan ❑ , Adobe .❑ Fill Ma _:......-_=. if es,typ (Plot plan, showing size of lot, location_of:,system_in-relation to wells�buildings, etc:.must_lae:'laced�er�reverse side.) ON: (No septic tank or seepage pit permitted If'.public sewer is available.within 20.0. feet,); NEW INSTALLATION:I Liquid Depth ..`.._ . ................ PACKAGE TREATMENT [ ] SEPTIC TANK.1 ] Size..._...:•-•----••---•-••........................ F, .R... ,.-,.. ...................... Capacity .... ............... Type •---•---••--•- Materia l.----...-----•----_._. No. Compartments.I- s 6 - Foundation .......•......I.....-- P oP. L ne.•--•--- i Dlstance to nearest: Well ---...-••--•---- --------- 'Total Leng#h ............ --••---•--•- Elter LEACHING LINE [ ] No. of Lines ------------- Lengt�i of each line.---...-----'• ' _ ! Depth Filter Material - 'D' Box .--= Type F' Material k on ...._..:._...---... Property Line •. . ........ ......... Distance to nearest- WFoundati . � _ . _. Rock .Filled�. Yes Na �Q� Depth ---Number ._ ._-- SEEPAGE PIT [ ) p ••__--•• Diameter ....----• - Water Table Depth .........Rock Size ................................ -----• --:...... . r_. � ...----•----•- Foundation Prop. Line .......--------••-•-•-- � Distance to.nearest- Well, " --•---- --- Date .......) REPAIR/ADDITION(Prev. Sanitation Permit# •-.--'• . Septic Tank (Specify Requirements) . - - � :. ._. . . r � ..� 1 - ! .. ... Disposal Field Spedfy Requirntsl •••---- -Q " � �� i .................. , 1E� ...... __. ._. .._.. = ................r_......•_..__.. --- ------------------- _ '•'•---� (Draw existing and required addition on reverse`side) , I hereby certify that.l have preparedve�this application,and that the work wiii .be done in accordance with San Joaquin County Ordinan-e State Laws, -and Rules anti Regulations of the Son'Joaquin Local Health District.'lHome'owner or Iicen= sed agents signature certifies the following: "( - A r °'I certify that in the performance of the work for which this permit4s issued, t shall not employ any person in such manner as to become sub•ect to Workman's Compensation laws:of California.";' ' " { Signed ---- .......................•-•-........._... - Title (If other than owner) i t FOR DEPARTMENT USE ONLY --- ... ------ ... DATE-. ..;. -- ... --�-_ .:.. APPLICATION ACCEPTED BY ........ ...:.:.:..:..:::.::------------------ I BUILDING PERMIT ISSUI±D ............:...::..:.... ADDITIONAL COMMENTS - ..........1-.... ._....._ do b : ..._ _ .Co . ......---- Date ..d - �` - Final inspection y •••• , SAN JOAQUIN LOCAL HEALTH DISTRICT 13 24 1_-An Rau sw