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. _ A __. .v_-„ • LICATIOc FOR SANITATION PElti Permit No. 9 / ons lett Is-Trl Ilcote x .x: .cr.....•,��... . Date Issued .............�......:...�............... This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Loco! Health District for a permit to con a install the work herein described. This application Is made in compliance with County Ordinance No. 549 a d ng ul ulatlonss . . .............. �C.,6�f... r........CENS S 1"ii"A .309 ADDRESS/LOCAT -c7's. q Owner's Name .... ........ ... :i --•..............•-•- ... ............ ..Phone ..� -b..M L. aAddress .............. - .*'... City . f ..................................... Contractor's Name __.I~:. r' t-„ ;tilt......license c -fir�' i� �' Phone�� -- Installation will serves Residerue Apartment House Commercial QTraller Court Motel ❑Other............................................+ . Number of living units:... Number of bedrooms . .....Garbo a Grinder .__ . .... Lot Size -oZ0.... ' ------- Water Supply: Public System and name •._1 ......_......-...................................Private' Character of soil to a depth of 3 feet: $and E3 Slit❑ Clay p Peat❑ Sandy Loam ❑ Clay Loam ❑ p ` Hardpan Adobe❑ Fill Materlat............If yes,type........................... (Plot plan, showing size of lot, location of system in relation to wells,.buildings, etc. must be placed on reverse side.) NEIN INSTALLATION: (No septic tank or seepage pit permitted if public sewer Is available within 200 feet') I PACKAGE TREATMENT ( ] SEPTIC TANK SiY.- Mlaterlal?Ll-e�. o. .... . �� ... Liquid Depth ...> _.............._ .. paCompartments r ' Distance to nearest: Well ...t rd.. Foundation ./a .__...... Prop. Line . ` Total Length .. ..Y .-ch line...�� ............ ----•• i /................ Len . LEACHING LINE Na. of Lines...... .. 9 'D' Box .�-__ Type Filter Materigl �.1. ....Depth`' Filter Materlal '01........................ --- . Foundation Distance to nearest: Well 4 .-.....--__ ..... ' .... Property Line ..+5............... SEEPAGE PIT Depth --- ...... Diameter a .4- ..... Number ......./..............:..`'Rock`Filled Yes No O Water Table Depth ..... .................................Rock Size ..g=�Z..:` . ........._ Distance to nearest: Well /V.a.... ..................Foundation ..1 .......--prop. Line ....�-•.-....... REPAIR/ADDITION(Prev. Sanitation Permit# •........................................... Date ..._----........ ................ SepticTank {Specify Requirements) ........................................... ...................................... .................................................... # Disposal Field (Specify Requirements) .........:............................................'..........................................:.........-.................... ._.. ......................................... .................. ' .....------.......-•------......... .......-...---.......----............_....... ...........__.... ...........-.................. --• ......................................................,..................................... I (Draw existing and required addition on reverse side) ' I hereby certify that I have prepared this application and that the work will be done lin accordance with San Joequln County Ordinances, State Laws, and Mules and Regulations of the San Joaquin Local Health district. Home owner or)icon- sed agents signature certifies the following- 41 ollowing: "I certify that in the performance of the work for which this permit Is issued, I shall not employ any person In such a+anner as to become subject to Workman's Compensation laws of California.” Signed a ... .......................... . •--- ...---....---.........-.__. _.. Owner B ._....... Title .... ..' -�- -X, ........................ ..... (if other than owner) R EPARTMENT USE ONLY APPLICATION ACCEPTED 13Y.. �` .............:..........:: ....... ....J . ....._.. ;, ..'. . .. .. DATE - ��J'� BUILDINGPERMIT ISSUED ....... . ... ... . . . ................... .............................................DATE ........................................... A DITI AL COMMS ......... • .......... ----.....:................... . _.-. ........................ ............ ..... . .......................... ......... . ......... ..-------- • - ..................................... ..........I.....................--_..-.. .. _.. Final Inspection by: ._...___.- - ---- .. .. . - -- ---•-- •--...... ...............I...-------............Date . , /.� �Z ...... ... Eli 13',211 1-613 JOA IN LOCAL HEALTH DISTRICT 8/71 3M