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- - ____ ..------•-..--• . ! APPLICATION I`OIt SANITATION PERMIT ....------••---- t f (Complete in Trlpl€cate) Permit No. ..Z'`_- �`._ t } This,Permit Expires 1,Year From DOM Issued Dote Iso Application is hereby made to the+San Joaquin local Health District fora permit described. This application is made in compliance with County Ordinance No 549 and existand ing Installl the Regulations..orhein r JOB ADQRIrSS/LOCATION ......( - !.. i ...............:........CENSUS TRACT Owner's Name - .. f Address _- .... ..�-.3.1-ti3._-.. RSP,g.._ . .... c...................... ... ........ .._...:............._..Phones 6f:f s:.2!K.....-- -••- -IAC. City ............. .. .. Contractor's-Name ._....-s�3°�_• ...................................................... ................••- License •----••. ..................• n Installation Will.serve: •- ....................... . . Residence Apartment Housefl Commercial oTrailer Court 0] Motel p Other..... .... Number of-living units:_.-.4 -. Number of bedrooms `� ' _--......._.Garbage Grinder _'..... .... Lot Size �•��/!y'c�. Water Supply: Public System a •••-----..•. Y and name ........ Character of soil .. ................... ........._......._.....Private to a depth of 3 feet: Sand d Silt . CIO - _ P l ate Y Q Peat El Sandy Loam� Clay Loam Hardpan Q Adobe❑ Fill Moterlal ............ If yes►ty pe ............... .... {Plot pion, showing size of lot, location of system In relation to weds, buildings, etc. must be placed an never NEIN INSTALLATION: (No septic.tank or;seep a pit permitted if public sewer is available within 20Q feet+) se side.} i PACKAGE TREATMENT [.] SEPTIC TANK' Size_.................... c0arity 19th._.... TyPef.W_ �>�-_ Material - ..... No.. Comp ....... 6 -••-- Depth I m iftance to nearest: Well ........../ . ........ --••--•••--.........Foundation .:. Pop Line 6'o`r� Compartments /O� LEACHINGLINE' _....... -- ................... ........._.. ... ( No. of Lines .- ,,_.----.•_.._ g • — -- i Len'th: f each line._..- v .. Total Length Box .e."_ .. .............................................. 2 4F0Distance t crest Welter, ria!^S .s. �epth Filter Material ..:....Z-..! ....... ✓�---••_••• . `' Foundation { h -_../ :x p„ ......_... Property Line . .f ... . i3epfi '.........__: Diameter _--____ Number -Z �� / ...•---- . Rock Filled Yes � No Water Table Depth __........ •--•- Rock Size Distance to.nearest . Well ......0%> __....--•....._Foundation REPAIR - ......•....:......:. Prop 'Line........................ /ADDITION IPrev. Sanitation Permit I ...................::..... Date Septic Tank ISpecify Requirements) - --•---•-------••-----••• ... ..._.. Dis asci Fie! ,, .......--•-................... ..:.:. P d (Specify Requirements) ..................... .............---------••---- ---•-..._ _ ...----•-..... - --------------- :.. ..................... .. ---•-- (Draw existing and requi---•--------------------•---•_•--•------------.......... ................ red addition on reverse side) I hereby certify that I have prepared this Opplication and that the work will be done in accordance with San Joaquin County Ordinances, state Laws, and ltules and Regulations of the Son Joaquin Local Health.Dlsidd. Home owner or licen- sedagents signature certifies.the foilowing; "I certify that inthe performance of'the work for which this erWt Is issued I shall not employ an as to beco bleat to Work •s Co California," Is y y person In such manner I pensation laws of C Signed ---- Owner BY ----- •---- ------------------- _._._ Title ---- (If other than owner --•-- FO�DARTMENT, USE ONLY APPLICATION ACCEPTED BY •- - BIjILDING PERMIT ISSUED - PATE. .-.. .- "!� � ---------- ADDITIONAL COMMENTS ............ .....!.._- ...... ---._..._.... -------- ----- _DATE ..................... -- --- --- -------•-------• ............. ------------------------------------------ - ..-_--_-.--- -------------- --. ---_-------------------._...............•.......... - .. Final Inspection by: ---------- -.....`�-- _-•-- _ --------- --------•-...--•----------- --------------• -----• ----- ER �3 2! 1-68 flev. �I Date �-...._ . .. ........ ... . . + AN JOAQUIN LOCAL HEALTH-! DISTRICT 8/7h 3M x I