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FOR OFFICE USE: APPLICATIONFORSANI7 ATION PERMIT "a Permit No.11�3— l 3 k ---------- ------------- ----------- ----------------- ;Complete in Triplicate} r, f Date Issued ,This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install,, the work herein described. This applica 'o is made in compliance with County Ordinance No. 549 and existing Rules nd Reg at ons: JOB ADDRESS/LOCATION , ,� -'ke � � f 1=Nsus TR ' Owner's Name X177- = �,=.�?-f��/' ' � < --------------------------� Phone --------- Address '� c -`--- 'f �`r ---------------------- City ��{s! _ Phone. `...f Contractor s Name --------------------•--- ----------'------------------------------- ---------------------License #d- " �� Installation will serve: Residenle %Apartment House°C] Commercial ❑Trailer Court l❑ t . . Motel ❑ Other -------------------------------------------- 1 Number of living units:_____.__ Numberof bedrooms "______Garbage Grinder /0"0... Lot Size __________________________________________ r - Water Supply: Public System and name ------------------------------------------- ------- -------------------------- -------------------------------Private ❑ k Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam Clay Loam ❑ . Hardpan ❑ Adobe ❑ Fill Material ------------ If yes. type __________________________ 4 (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) a seepage pit permitted if public sewer is available within 200 feet,) W NEW INSTALLATION: (No septic tank,-or ii /\ d f P PACKAGE TREATMENT { ] SEPTIC TANK' S' e--- -- s"'f--- Liquid Depth _ -----_-.--,----. r Capacity/ -- --- Type Material_ .1s No. Compartments ---- ------- t ' ��j�'�'/� Foundation Distance to nearest: Wel ----___1t__tl________________ _ - Prop. Line __ ________=_ Length of each fine._. s Total Len thf.�___...-�'_._- LEACHING LINE No. of Lines -----ti g t--- 9 D' Box y- __ Type Filter Material1 ,fie-_Depth Filter Material / f h- _ :___. •--'�'...-. Distance to nearest: Well _A!5''!--------- Foundation --- --- Property !Line. --.Jf--------":a .-- 4 SEEPAGE PIT Depth �.��,---- Diameter s,�-_ ______ Number --._.__�------ -------- Rock Filled Yes No ❑ ,< ,y. Water Table Depth -------��----------------------------Rock Size _ ------------- Foundation Pro Line ___ --------- Distance to nearest: Well ---- __________________ _ �. � r �op. REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ____________________------__-__-- Septic Tank (Specify Requirements) ------------------------------------------------------------------------------'---�'-------- --------------------------- - ------------- - i Disposal Field (Specify Requirementt;)i,------------------------------------------- -----��------ �# - -------------------------------- ---------------------'--------------------------------------------- w._4 ------------------------_------------------- ------ . 44.,4 - � (Draw e�isting 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 7/-V.certify that in the performance of t6 wwhi ok€or ch this permit is issued,. 1 shall not employ any person in such manner as to become subject to Workmen's Compensation laws of California." 6 N ; Signed ---- ----- --------------- - ----- -- - ----- ---------------------------------- Owner i 1{y t } k EBY`-- --- -------- --- -- ----- - - --- - � -------------------- Title -- -- - ---- i other than owner FOR DEPARTMENT US ONLY - - ' APPLICATION ACCEPTED BY - ----------- ------. --- ATE -, BUILDING PERMIT ISSUED ......... -------------- ------------ -------------- -;--------------DATE --------------------------------------- ADDITIONALCOMMENTS ------ -------------------------------------------------------------- ----------------------------------- -`------------------=-------------------------- 14 --------------------------------------- tM_ __________________________________________ ------------------------------------- ._..___---__________________-.--__._____________.___---__________________ �__-.y _ _ ___ Final Inspection by: . - = Date - -------- -- ------------------ SAN JOAQUIN-LOCAL HEALTH DISTRICT �t IE. H. 9 1-'68 Rev. 5M •:' r i �: '�"`� `'.,