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! FOR OFFICE USE: - LICATION FOR SANITATION PERIV, ) Permit (Complete in Triplicate) -_ ------------------------------------------------- Is -- ------- --------------- Is ed _73. __________________________.__________________ This Permit Expires 1 Year From Date Issued O Application is hereby made to the San Joaquin Local Health District for a permit to construct and 1insta I the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION }OC r k (0--,----- -- H7- '--- -7Q_- ---6=--g_rl• �ENSUS TRACT __.Y.7--------------- Owner's Name -- /2G�I-. -P.�G[ -15------------------------------------------------------ •------------------ Phone ----- --�--------------------------- F Address _23.7-0-,- . �"'R•nSl _. - ----------- ::'City __ _. /� �. .d "`-0 ....._.. ---:---------License .� _8�2 Phone_ �_ S Contractor's Name 1l � • + ' Installation will serve: Residence artment House❑ Commercial :❑Trailer Court,;❑ E Motel ❑Other --------------- - --- - --- - - - --- - - --- Number of living _____ units:__ ___ Number of bedrooms _ Garbo a Grinder ------------- Lot Size -------------- ` Water Supply: Public System and name __________________ _____ ...Private g4_- -&I; 4_— W �, LabbWr5------------- Loam Character of soil to a depth of 3 feet: Sand b Silt❑ Clay �� Peat❑ Sandy Loam ❑ Clay L' N1111 r Hardpan dobe '❑ Fl11 Material ____________ If yes,type .............. + (Prot plan, showing size of lot, location of system in relation to wells, buildings, etc: must be placed on reverse side.) �1 NEW INSTALLATION: (No septic tank or seepage' ;sewer is available within 200 feet,) s PACKAGE TREATMENT SEPTIC TANK Size.----- ------------- Liquid Depth ------- Capacity -- --- t Ca aci QQ _ xx e _______________ M 'tenial __-__e-. sNo. Compartments p tY +Yp / l P \1 ....._.... p de Distance to nearest:--Well--- L'� � a ch line_______ -d_�:__`4 Total Length'Line _.,- ------------------------------------Foundation ------------- ---- Pro 3-0-------- LEACHING LINE { ] Nq. of Lines ------- _ g eq a --- - g ` -- - :Q----------- Al e 'D` Box ____I------ Type- Filter Matenah_Zi'�:�1�'r� pth Filter 1_ . ........................j........ Distance to nearest. Well __`7 __--_-.. Founcd ion _________________ - Property Line ____________ � � SEEPAGE PIT [ l Depth __2__��________ Diametier _ ✓...__ Number _ _____ __ Yes '@g---No Water Table Depth __.__.-_ _Q-Q--_ __ Rock Size _ �� Rock Filled Distance to nearest: Well ------- _w........._--------Foundation ------- Prop.",Line __2 Q.._...._. REPAIR/ADDITIONa Prev. Sanitation�nitation Permit# ------- ------------------------------------ Date ................................... . SepticTank (Specify Requirements) ------------------------------------ ---------------------------------------------------------------..--•----------------- -. DisposalField (Specify';Requirements) -------------------------------------------------------------------------------------------------------------------- --•------..---- ------------------------------------------- ---- -------------------------=------ •------------------•---- -------- -----------------------------------------;- -------- ---- ------- (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 S6ri 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 Compensatian laws of California." Signed -- --------- -------••---- ------ Owner BY G f - - -- -----•---------- -Title ---------- � G I---G�I--.........:...... R (if 09r than owner) F ' FOR .DEPARTMENT USE ONLY t APPLICATION ACCEPTED BY _._ __ . __ _ _ - --------------------------- --------------- DATE �a = --�'T ------------- BUILDING PERMIT ISSUED ------- --- ------------ •--•-.------DATE --=----------•------------ ---------------- ADDITIONAL COMMENTS ---------------------------------------------- - � � - -- --------------- - r - - ---- ----- --------- -- -- _ -------- f ----------------- --------------------------------Final Inspection b - ----------- SAN ---• --- SAN JOAQUIN LOCAL HEALTH. DISTRICT J E..H. 9 1-'68 Rev. 5M