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FOR OFFICE USE: IV A"LICATION FOR SANITATION PERMIT y Permit No- ----- --------------- ]Coen lop h in Triplicate) •............... ......................................... This Permit Expires f Year From Date Issued Date Issued .5_: :'�..' 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 mode in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCA 0t, ...CENSUS TRACT Owner's Name _. •--...._.._llGl-I_/ _e_/�..................r.............................----•---phone ---- --...._.--...........----- Address II..-.2 _._._.._[,�..._...�..��..�.'`l ---City ....--•--..-..--............................... ..................... c Contractor's Nome -/— t -?--- .......................License ` . ,. ,/ Phone .......••---•----------------- Installation will serve: Residence Pf rt ent HouseQ Commercial QTroller Court 0 Motel ❑Other............................................. Number of living units:...... Number of dro s E,,. Garbage Grinder yey- Lot Size . d/!.; . ...............Water Supply: Public System and name -... ..........- ----.tt.x^'�.._..: ..�+- �-. .....................•.....•_•..Private Q.. . .. Character of soil to a depth of 3 feet: Sand Q Silt Q Cloy Peat Q Sandy Loam C] Clay Loam 0 . _ ..Hardpan 0 - Adobe ill M6terial ............if yes,type............... ............ (Plot plan, showing size of lot, location of'system in relation to'wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT j ) _SEPTIC TANK fU] ;;jxe--- ,� /--•-------- Liquid Depth ... 3..12.2.. ,...__rt_ Capacity J r ...--__-- Typef1w.-G�'' . Materia .?.i 1. No. Compartments ... ....... D' tante to nearest: Well ...., -„ rd!' _ - . ........Foundation .. �f......... Prop.-Line .' ----J_._....... LEACHING LINE __--_ Length of each line.k.,�.� �.... �'. ......... [ No. of Lines 3333_-� 1111-- .. �.. Total Length'., -�--__-... 'D' Box I-.W.... Type Filter Material �J�!Y'......Depth Filter Material 1419.................................. Distance to nearest: Well .,Al. ........ Foundation Q . Property Line --_. � �= 3333................. p rtY 3133 3133 3333... SEEPAGE PIT [��Depth .... �._. Diameter �3,�..�. Number _.._..�----._..1._........ Rock Filled Yes W-- o� Water Table Depth ----------- • ---------------------Rock Size _.!.% .��.�..._.._. J ' Distance to nearest: Well Foundation ...... Prop. Line 5. .........l� .---•••----••. REPAIR/ADDITION lPrev. Sanitation Permit# ..............---3333.-----•----•-..------__ Date ----------- ) .. SepticTank (Specify Requirements) ............................ ........•......;..................................................................--.......................... DisposalField (Specify Requirements) ............................................................. .............. .......................................... 4 --•---------------------- ................-•--..............._...._..••-••-.........._...._........._.....----.........._•---- . : ...---------•............. 3333 .. - - �....._..�. 113^3 :; •--•------ ---------------.---------------------------.............•-------------------------------...................... •--•------ ......................... (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 County Ordinances; State Laws, and Rules and Regulations of the San Joaquin Local Health,District. Home owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person In such manner as to become subject to Workman's Compensation laws of California.” Signed ----- `ti'_ = Owner ...............f...------.......... Title 1333 -.tom_ -� L (if ther than owner)' '-' --- _ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY __. ------------------- DATE ..Z. �------ •---_- BUILDING PERMIT ISSiJED / _[�._ _ _-.- .. _ 1,311... _ --- ---•-- ?T�- -_�5=fin -_._77 ! I ..-IRATE ..... ........_.._._......--...........-_.. ADDITIONAL COMMENTS _L-rrnl ---- --/ fi--- �.t�.._.f9.K_... 1l�IS E �-10n1.---J `l-__._ .Sir...................:...................•------- t.!?1_R y5.7` A-2- 109 ., V.ti1fl.Qk-�_..T_0_._---V,0 c1 ........... 1=-D..i3__.-4 Qv7� .._.�!}, �P?P+ui:nQ_FNSt LP--------..QN_._. 1IIS ST M33`3-------•---------•------- •- ---- ........ -------------------------- r -------- - - - - - - --3333_ . . . - ---•--------•-------- -- --------3133.-- ---- --- --�---- -- // Final Inspection : 3133._ -------------Date _._. _.%�__ ...-- ---------------- ._.._'......... .. 13 2h i-b(iv. SAN JOAQUIN LOCAL HEALTH DISTRICT 87[1 3M