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FOR OFFICE USE: ` - -- �_ 3v APPLICATION FOR SANITATION PERMIT - --�- ,complete in-Txiplicate).,.,,�..._ ____„�.. Pe No. c�/j y --------- --------------- This Permit Expires 1 Year From Date Issued Date Issued _/d_`- �__-93 Application is hereby made to the San Joaquin Local Health District for a f described. This application is made in compliance with"•County Ordinance No 549 and ermit to nexistingnRules tand Regulationl the work s. I JOB ADDRESS/LOCATION .__.��,�- _ .- --�_�------------------ -1---- E Owner's Name! - CE --------------- M-- --- SUS TRACT --------- --- -- --- ---- - -Phone ,�,�,�-•��-<�/��J- Address '� • - -----------------•--- - -- -----------. pry ------ Contractor's Name --------- ------------------------ � License # � Installation will serve:. � -� - Phone Residence 0 Apartment House,0 Commercial Wroller Court 1❑ Mote! ❑Other- Number of living units:_ . -- Number of bedrooms___ ____ Garbage Grinder ------------ Lot Size _ - �� Water Supply: Public System and name ------ --------- - --- --- ----------------- ------------------------ -- - Private aracter I,of soil to a depth of 3 feet: Sand'E] Silt❑ Clay ❑ Peat❑ Sandy Loam Ej Clay Loam ❑ t Hardpan 0 Adobe*f Fill Material ------------ If yes, type {Plot;plan, showing size of lot, location of system in relations t'ow ced on reverse side.) ells, buildings, etc, must be pla } i NEW,INSTALLATION: t {No septic yank or seepage pit permitted if pubfiic•sewer is available within 200 feet,) i PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] ,' Size { ' - Size______________ - A " Depth _____ __---- ---------- Liquid d Z'_-----------•.Capacity --- ---------------- Type Material N. No. Compartments; Distance to' nearest. Well --------------------------------/-.Foundation --____- -- --------- Prop. Linep----x------ LEACH WGLINE f,�/j No. of Lines _�_--__ ____ Length of each line_ i__-_--- f Total,�:L n'th -- ------- d' BOX T e Q / ! si #` �- -- / .� is/ ' Type Filter Material ________Depth Filter Material __- ` Distance to nearest: Wel! ______ - --------- Foundation _ Q--_:< SEEPAGE PIT Property Line ..... SEEPAGE , Depth _--___ Diameter - _;---�-�---- Number ----------1-------------- Rock Filled Yes ,�] No i[,( --------Water Table Depth __________- """` �/ �. � < { ----- '�� -Rock.Size — ----- ------ Distance to nearest: Well --------/ - •----------_-Found ons !,_- Prop. Line}__."i. # REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date st -----------------1 Septic Tank (Specify r Requirements) --_____--___ ----------------- Disposal Field (Specify Requirements) ------------ -- 0- ------------- ----- --------------- - (Draw existing and required addition on reverse side)i i I hereby certify that 1 have preparedthis application and that the wor*k wild be done in accordance with San Joaquin , a County Ordinances, State Laws, and Rules and Regulations of the San Joaquin`Loca ealf rh District. Home owner or 'licen_ f sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall not em to as to become subject to Workman's Compensation laws of California p yan y person in such manner } Signed ------ Owner S € w f J BY - -----`-- ' � --- Title L� - (If other than owner) + - ---� ------- ---- ' FOR DEPARTMENT USE ONLY _ f APPLICATION ACCEPTED BY___� r1l 5, _ " BUILDING PERMIT ISSUED ----------------- - -------- DATE _ Q--------- ---- - v------ - - ---- - _r -DATE ------- ---------------- ADDITIONAL COMMENTS-------- - ------ -=---- ------ --------- --------------------------�---- ------- --_-=- .� -----•---- ----------------------;�s � ------ ----•--- 4 -------------------------------------=�------------ ------ -'-------------------- - - ` - ---------------------------------------- ! Final Inspection b ........ ........ ------------------ Y- ---- --------------------------------------------------- ------------------ ---- •.-Date 1 SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M