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FOR OFFICE USE: APPLICATION'AOR' SANITATION PERMIT _ ----------------- ----------------------------- o` -lete FesiPermit No. �,� Y ice/ ------ (Ctnpn Triplicate) ------------------------------ Dare-lssued.. /3---G-----z This Permit Expires Y Year From Date Issued --------------------------------- Application is hereby made to the San Joaquin Local Health District for a per to constr Brand install the work herein described. This applicati is min compliance with County Ordinance No. 549 and existing Rules and Regulations: -------- 7GENSUS TRACT -------------------------- JOB ADDRESS/LOCATION .--/Y---- A0 - ----- `/------- - r f j one 3�'x_11-1----:-------- Owner's Name � p� 1 -- �?-A------------------------------------------ ---------- -- --------Ph T'O(:__'e eN---------------------•--------------•----•------- Address -----9/" � �sF y = `r------------------------------------------- Cit K G?rrr Lice - nse # ------------------------ Phone ---------------------------•-- Contractor's Name rZ------------------------ ------------ Installation will serve: Residence F"A"partmenf House❑ Commercial .❑Trailer Court ',E] iMotel ❑ Other ------------------------------ I--- E Ek Number of living units------.---- Number of Brooms _. ____'Gar ag under 'Ye-5--- Lot Size ---- _ -J00 .. T� _ _� ,T rte•-.- -._ . -i,� -Private'•❑- Water Supply Public ystem and name - F ----------- - ----------` --- -- -------------------- ---- Character of soil to a depth of 3 feet: I Sandilt Clay ❑ Peat ❑ Sandy Loam -❑ Clay Loam ❑ Har pan E] dobe [)� Fill Material ------------ If yes,type ---------------------------- [Plot plan, showing size of lot, location of stem in relation�to wells, buildings, etc. must`be placed an reverse side.] tic tank e a e it ermined if public sewer is available within 200 feet,) NEW INSTALLATION: lNo septic p 9 P P . PACKAGE TREATMENT [ I SEPTIC TANK'f ] ; t s � + N A �ze.---�'------------------------------------------ Liquid Depth ----- �------=•-------- -, �_� _ _ ---- capacity - f p • Y190-0-74j-- - - Type i��--- ---� Material_��°------- No. . Ca acct r ------------Foundation --- ,---------'--- Prop. Line ---•].2=-------- Distancelto nearest: Well ------------ Total Len th + No. of Lines �73------------= `} Length of each line ..... ?----------- -` 9 ----�� = LEACHING LINE [ ] .I . ., 'D' Box _.__ Type Filter Material _ilC ------Depth Filter Material ----�_-------`4 °----------•-• Distance to earest: W411 ----------- __--�-.-- Foundation ---------3--- - Property Line ----------------------- Distance ___f s..._-'- -- -"-• SEEPAGE PIT [ ] Depth - _�---/Diameter ------- ---- ---- - NumberRpck Size _____ Rock Filled Yes ❑ No Water Table. Depth>------------------------- -- --- "_-"""" • ti F ' Distance to n arest:f Well ---------------------`- ;---— Foundation -------------------- Prop. Line ---------------------- REPAIR/ADDITION(Prev. Sanitation P rmit# ---------- -- -----",_-_--- -------- Dafie --------•------------•-- } I i Septic Tank [Specify Requirements} --------- - = ---'---•--- ' Disposal Field (Specify Requirem nts};_ _,-___- ----------------------------- .' t4 ._ ----------------------------- --------------- ---- [')raw existing and required-a'-d-d-i-ti-o n on reverse side) I hereby certify that I have prepare I this application and that the work will be done in accordance. with San Joaquin County Ordinances, State Laws, an . Rulesand "e of the San Joaquin Local Health.District. Homeowner or licen- sed agents signature certifies the foll ;win_g:� l "I certify that in the performance of tore work for which this permit is issued, I shall not employ any person in such mannet as to become subject to Workman's �tlorrtpensationrlaws of California." Signed ------------ ------ ^Owner 5 } �. t - Title --- -------------------------------- -------.E -= ----------------By ------------ = --- (If other than owner) I 7 r .° FOR DEPARTMENT USE ONLY -------------------------- APPLICATION ACCEPTED l3Y s - �, DATE BUILDING PERMIT ISSUED ----------------------------- ----- ----- -- - .-" DATE_----- " = ADDITIONALCOMMENTS ---------------i----------------------------- - ----------------------- ---------- = , ---------------a:- ---- -------------------------- ------------ ---- --- ----------------------------- .' t _ z -------------------------- ------------------- - - —. - - --- --- --- = F � �- -------------------- -------------------------------- -- ---- _ - - . Final Inspection bY` """" _ _ t _ DISTRICTSAN }OAQUIN LOCAL_HEALH__ E. H. 9 1-'68 Rev. 5M