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FOR OFFICE USE: APPLICATION v FOR SANITATION PERMIT // GG �, "tit Permit No.4!f. - --- - --- �- � (Complete in Triplicate) , ;. .`` base Issued'--lG......... -., - ------- This Permit Expires 1 Year From Date issued -Application is hereby madel�to the San .Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in'compliance ith, County Ordinance No. 549 and existing Rules and Regulations: wi J. - ------------- -CENSUS TRACT ------------------JOB ADDRESS/LOCATION _�_ F I� Owner's Name -------- it - Phone - Address ---------------- .,-�- `` a -' -------------------- city --------------------------------------------------/------ Contractor's Name -P O ----------------------- --------License # , �� ' Phone : �c�------- Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court 10 Motel [7 Other ------------------------------------------- Number of living units:---f i------ Number of ooms�"".Gar a e inder�Q--- Lot Size �-�-� --• �. y Private ❑ Water Supply: Public System and name ____ --._.__ 6,7---------- r� -� Character of soil to a depth-Df 3 feet: Sand'❑ Silt ElClay ❑ Peat❑ Sandy Loam E] Clay Loam :❑ Hardpan ❑ Adobe Fill MaterialAfD-__ if yes,type ----------------____________ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side) s seepage pit permitted if public sewer is 6vailable within 200 eet,) NEW INSTALLATION: No f M septic tank or � r ,rte Liquid Depth ___ -- PACKAGE TREATMENT { ] SEPTIC TANK'," e---1=�-�--- - ��'-Z�-6----- p '"'""""-• �I No. Compartments Capacity�'�-�-C?---- TYpe � Maseria .7.1� ��---•�---- � it �� . Distance to nearest. Well __-._ _______Foundatio 0 Prop. Line_"••.-:--•--. - - --------------- ---------------------- ---- -- -- 9 --- __ _ Len th of each ine___ - Total Length LEACHING LINE NoM. of Lines _.__ g 31 li r! p� Box _, C3 Type Filter Mate rial _"_� epth Filter Material ._._ _Q______._..-_{---•-------------- ` Distance to ne rest: Well ________ ____________ Foundation - �-./. Property Line ___•? - -----..:_"-- t ^' - —' Rock Filled Yes [e No SEEPAGE Piz D th _. ^Y= -D a- mefer __ __ Number -_- �� . 7 1 [L _Rock Size ----- -_ P ;Water Table Depth -----------�-�- ---------- - --------- ��---------- - -- / � el �. Distance to nearest: Well _._"___� �^___----------- A---________ Prop. Line ---_----------__`:___.. REPAIR/ADDITION<(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------} Septic Tank (SpecifyRegeents) --------------------- Disposal Field (Specify Requirements) ------------ --------------- ------ � � ----------------------------------------------------------------------- _ (rt_ _-__ � —_ .- . ----------I-------------- --------- ------ ------- �I------------------------------------------------------------------------------------------------------------------------------------=--------------------------------------------------- (Draw existing and required addition on reverse side) I hereby certify that.l Ficve prepared this application and-.that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and .Regulatioi s of the 'San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following:' w— I "I certify that in the perfoemance of the work for which this permit is issued, I shalltinot employ anyiperson m such'manner as to become subject to Workman's Compensation laws of California." s Signed --------------------- -`- = 4 .. _. . lOwner ' ` itle ---- ---------- ------------------ f (If other th o ner) a I FOR .DEPARTMENT USE ONLY 4` Kiri D _ -_( :- APPLICATION ACCEPTED .CBY ----- DATE ___..- _ ----------------- BUILDING PERMIT ISSUED - ----------- ------------------------------------------- DATE . ------- ADDITIONAL-COMMENTS:-- ------------------------------------------------------------------------------------------------------------------------------- --------------------------- 1-0 qeX _ Final Inspection by: �. ,tQ.�- ----.Date -------------- `--- � - SAN JOAQUIN LOCAL HEALTH 131STRICT E. H. 9 ] '68 Rev. 5NC1 I