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.FOR OFFICI! USE: T` " APPLICATION ICOR SANITATION PERMIT ---------- ---- -----=--------- ---- ------------ _, - Permit No. fr'9�7------- ( o m ete in Triplicate) ; . , pl r f Date Issued _6_`174 -------- ------------------------------------ This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local .Health District for a permit to construct and install the work herein described. This application is made in compliance with.County Ordinance No. 549 and existing Rules and Regulations: 3 JOB ADDRESS/LOCATION- .--- 3 i_,_14- -- -------ESCA Qwners Name ---_-- . ------------------------- ---------------- - -- LOCENSUS TRACT -------6--r----------- - t)�F-P\---- �_ F G- -----------Phone ------------------.-..------------ Q Address .------------ - � 1 ---------CAME3 5--'--=--------- --------------• City --- L&)------------MM-------------------------------- Contractor's Name ---CSYI lq EE�R-------------------------j-- -----.License -------------------- Phone ----- ------------- ---------- Installation will serve: Residence gKApartment:House❑ Commere al,❑Troiler Court C] f � i ; Motel ❑Otherf----{----------------------------T------- i i Number of living units:--I------- Number of bedroom's r;2—_ ____.Garbage Grinder _Q%__ Lot Size c—Mn6�------------- __ Water Supply: Public System and name ____________________` ; __-________Private 2t— .� Character of:soil to a depth of 3 feet: .�Stind]],7 Si,It❑ c Clay..❑ mPeat❑ Sandy_Loam [ .Clay Loam:[] '-`�.-" � Fill Material --- ------ If es,type ---------------------------- 6 ---------------- : Hardpan � Adobe��❑ Y ---------- " ` bi.',€`«- buildings, etc. must be laced on reverse side.) )Plot plan, showing size of lot, location of system inrefation to wells, g p NEW INSTALLATION: (No septic tank or seepage pit pe fmtf d if public sewer is available within 200 feet,) PACKAGE REATMENT [ ] SEPTIC TANK T ] Size-------------------------------------,------------ Liquid Depth --------__---------.------ Capacity 7777771Ype� '` Material Na. Compartments Distance to nearest: Well i_-"-- = -- ------------\:-Foundation ---------------------. Prop. Line ---------------_------ r LEACHING LINE [ ) No. of Lines -------------- --kr____ Length-fbf .each line_;._.________--------_--_.-_ Total Length 'D' Box _--______.. Type Filter Material -0------------ ----Depth Filter Materia! Distance to nearest: Well ------------j----------- Foundation _.____._- ------------ Property Line -----.-._- .--. Dibmeter Tlumber Rock Filled Yes No SEEPAGE PIT_ Depth - ❑ Water Table Depth Rock Size ------ _._ _ --' i ---------- A Distance to nearest: Well ------------------------------------.___Foundation ______.__ Prop. Line ________________..__.. REPAIR/ADDITION(Prev.,Sanitation Permit# -------------------------------------------- Date ----------------------------------) SepticTank (Specify Requirements) --------------- --------------------------------------- --------------------------------------------------------------------------------- Disposal Field`.(Specify Requirements) ---- ----- 0------------_M--------- F)- f► C_- ---- ---- -------- _ - _ ,. . ., .- ..,.@�..- ,. -------------- ----------------------------- ------------- - �- # l (Draw'existing and-required addition on reverse side) I ,hereby certify that I have prepared this:application and that 'the work will be done in accordance with San Joaquin Cgonty Ordinances, State Laws, and Rules an y,,Regulations:of the San Joaquin Local Health District. Nome owner or licen- secl,genfs'$signature certifies the follci.�,t�if ' "I certify thcit in the perfor' once of tFse vYork for which this permit is-issued, I shall not employ any person in such manner as tobec a sub ectlto .! k nes Com'ensatibn laws of California." h .... y } Signed, Owner Y =-'-- fi fi .. le B ------- Tit l,f other than owns', . V .DEPARTMENT -USE ONLY APPLICATION ACCEPTED] BY �_R,_fl --------------- ----------- ---------------------------------------------. DATE -_-- �_�- -- -- --- BUILDING"PERNIIT`ISSUED " �" . ------""""-"" '" "-- �" " '�"`::'-DATE -----�'..,'"..�"^''��......_.: ADDITIONAL COMMENTS ------ , : ' `='i r� ') 7 - ' i --------------- -------------------1 ------------- -- - - ------ M _ . - _ - J� ----------------------- ------------Date ------ P Final Inspe ' _ ! SAN JOAQUIN LOCAL HEALTH DISTRICT t. H. 9 1-'68 Rev. 5M