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FOR OFFICE USE: ' ,- -- LICATION FOR SANITATION PERN s -•----------- F (Complete in Triplicate) Perm it-No: ._7,3_------------ ----------------------------------------------- d -_ --_.---_ = --------------------------- = y ------_-.--- This Permit Expires 1 Year From Date Issued © s d �--------- -�-.. ©7 Application is hereby made to the San Joaquin Local Health District for a permit to construct.and instal the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: �7 JOB ADDRESS/LOCATION Pa,_rc_[_C.?_.--- fLY►27s---4-J--7a, ...$y `CENSUS TRACT -S-`�- ---•----------- Owner's Name -------6- -- --- -r--• ----& - ------------- - - --•-•------------------------------,[-�l-.---------- --- ------Phone ------------- ...--------------- J0 ----------------- ---- -------- Z!To.............Address - 23- d City Contractor's Name --- ,(_?-C- t' --_ License # �.g 3.!.,Z Phone�_ / ,_gin �._6... Installation will serve: Residence &ikpairtment House°❑ Commercial ❑Trailer Court 0 Motel ❑Other -----�- --=--------------------------- Number of living units:____ ._----- Number of bedrooms -.3-----Garbage Grinder ------------ Lot Size -__-__--..-- -------- --------------- Water Supply; Public System and name ------------------ --„__ sg -----------------------------Private Character of soil to a depth of 3 feet: Sand Silt Cla e��5and Loam Clay ' P' E❑ ❑ Y y ❑ y Loam ] f Hardpan p ®Adobe ❑ Fill Material ------------ If yes,type --------------------�----___-- (Pl'ot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed' on reverse side,) NEW INSTALLATION: (No septic tan -or.seepage pit permitted if public sewer is available within 200 feet,} Capacityl 00 �• �� .. p•.h -.- Q Li vid Det rt PACKAGE TREATMENT., SEPTI TANK Size_-- 4 I_._ ----- -- .-- q ------ F ��t Type ?__ pct `sMatenal.- No Compartments. ......Foundation ---------------- Pro Line ...a ----- .. Distance to nearest: Well �.__ _________________ _-_--_ �-�-,-_-__••, P•, { l - ---' ongth. ofeachline._J____ . O�' _._ ___ Total Length c Cr LEACHING LINE No. of Lines i_--______-- L`{ D' Box -__ ------ T e Filter Material C.-kDe th Filter Material t .f ......... . .t. .. o0-1 Property yLine - -0. ._----istanceto nearest: Wel! undation" _ ii SEEPAGE PIT [ ] Depth :5_'__.__ Diameter. _-�----- Number --------- ---------- Rock Filled Yes E�r`No C Water Table Depth -----------------2-Q.0----------.........Rock Size -------1--r. --------------- r Distance to nearest: Well _..__el__o.Q________-____�____ ____Foundation �.__ Prop. Line _.. _�...--_-- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ------------------ Septic Tank (Specify Requirements) -_----_--_______________ •------------------- Disposal Field (Specify Requirements) --------------------------------------------------v -------------------•-- ------------------------------------------------ --------------- ------- ------------------------------------- ,, - _____________ -----ice__..»_.__-.____ --------------- ----- (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, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ------- --------------------------------------- ----- Owner I e472-�_ _ BY -••------------------ Title '? other than owner) FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED ------------ -------------- ------------- DATE.- a ------------- BUILDING PERMIT ISSUED ------------------------ --------------------------------------------------------DATE -------------- ---------------------- ADDITIONAL COMMENTS ---,}- _... - '- A._ _________________________________________G' � ''�`'; ,r� .yy n..:}rr `”' �{ _ _ ~� --------_-----.---_---_ _-_.------_-_.__-----__---_-_-_- _ - - -------- ----------------------- ------------------------------------------------- Fina! Inspection by: -----------••--•------------------ -------Date --r-• : ------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1268 Rev. 5M i