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w> �" FOR OFFICE USE: t rCom tete in Tri SANITATION PERMIT ----- ----------- ------------ ------------------------- APPLICATION FOS SANT ` P plicate} Permit No: ---------------------------- 4 I _-_--------- This Permit Expires 1 Year From Date Issued 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: JOB ADDRESS/LOCATI N --_ I _ -_,- ..__jr pp // ++ �yy�� ......... ---------- --------------CENSUS TRACT -_ j Owner's Name !-!ill)=-------- ----Ph - e - ----------------� . -_.-- Address J f �--- (fo 1-i��----------R D---------------- City E5C*q40 Contractor's Name ...~%F ---------- License # -------------------------------------------------- ------ Phone Installation will serve: Residence [Apartment House-E] Commercial (Trail r Court Motel'❑.Other------------- ------------------ N u mber ----------------Number of living units-------- . ^` 4 ^� 1--_ Number of bedrooms _3--_--Garbage Grinder ._Lot Size -.f`t�l _ __-_-- ----- Water Supply: Public System and name __________________ j '_ - Private -----•----------- ------- _Character of soil to a depth of 3 feet: Sand' Silt ' ❑ ._ ❑. '.%Clay ❑ Peat❑ Sand Loam ,E] r _ Y ��_ Clay Loa Hardpan �Adabe '❑ '-Fill Material -Alb- If yes, type ------.---�` fi (Plot plan, showing size of lot, location of system in relation to,wells, buildings, .etc. must be placed ons reverse side.}` NEW INSTALLATION: (No septic tank or seepage pit permitted ifjpublic sewer is available within 200 feetj, s U es PACKAGE TREATMENT,{ ] SEPTIC TANK'[ Size_! /Q --_ Liquid Depth . .- ------------- Capacity 1240-0--- Type??E[ftS7-Matericil_-IC:OIV4::R"`-No. Compartments j ...... _�_--_ Distance, to.,,nearest: We`ll "* _ - #-R- / .4 ; Foundation I ------- —1 Prop. !in ; -- - [/� No. of Lines t , - ----�-�-,��-____-- Length of each line.-�•;-- ._ r LEACHING LINE g 7 _---.___--_ Total Length-.._______-_ 'D' Box ��.�Type Filter Material -�o -Depth Fifterr Material -.--� -----------i0 1,______j__Distance_to Inearest:Well_. _ : 1 Pro {,_�_ �-_ Diameter;, + Foundation._:== --4--'�` - -4 --- =f.�------- "Number , ------- - Property Line. �- --' ---•-----•- SEEPAGE PIT [ Depth -- �i + --_Nurr�ber------- --- ------ Rock Filled Yes No Water Table Depth........ '., . r- , t �❑ "W;': ,; Rock Size 2 r Distance to nearest: Well ------/19C�--."'�-______________Foundation :f/ r �� ;--- Prop. Line REPAIR/ADDITION(Prey. Sanitation Permits -------- ---------------------------------- ' 'D�a-t-e---------:,---a--_-- Saptic•T�k (Specify Rquirements) -------------y---------------------------,:-_- --'-}------ - a _ .. Disposal Field (Specify Requirements) -------------------------- -------------------------------------------------- -- s c_ `-"_"� '_ - �;,-� _ -- ---- - ------ ---- Y .. .i r�- - w I (Draw existing and required addition on reverse side) . it I I hereby certify that 1 have prepared this application and that the work will be done inx-10cordance with� San Joaquin k Count Ordinances State Laws and Rules and Regulations of the Son Joaquin,Local Hea th Lis rict. Flome,owner or licen- Y g q I! sed agents signature certifies the following: " f "1 certify th the performan of rework for which this permit is issued Ishall not em 'lo an r,<< p� y y person in such manner as to beta bject to Work 's ompensation laws of California." Signed -- -- -- - - Owner ---------------------- By ------ .................... ------ f I .!'title I {If other than owner} -t yrs FOR DEPARTMENT USE ONLY APPLIC-TION_iACCEPTED--BY----- - 1' "_ :;-.I� .i i.1 i -�" .�. A115, -BUILDING _- PERMIT ISSUED --_----_-.---_ -__-- -- TnZ7--7„J�- - ------=---------- DATE - --------------------------- ------------ ADDITdONA�L�COMMENTS _= --= �,=,x r� _ = - . :` --____-=- -_: _ =_--- _._._ .. _ _.. (�` - - - ---- -------- �_ -- __ w -Y Final lnsp on by ----------------- - - ------- ------- .... SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M