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FOR OFFICE USE: APPLICATIpf ON rOR SANITATION PERMIT .......... - - - .;�..`$�8`i ICor ii:;ete in Triplicate) Permit No. "` .....--•••.....-•------- 01 ----------- This Peimit Expires 1 Year From Date Issued Date Issued c�3--o7c) -13 Application is hereljy,.made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This appUcation is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: Qa n S_ Fes- aJ�j�T ' JOB ADDRESS/LOCA�T,I,OAN Y/1 .. ... .�� * US TRACT ...._.. ... Owner's Name . . .Y�'1..'�l%2�Z Q�. .!'"a'o2...... \� ----..__Phone ,7, .Z j�y ..... -- Address --------- - J.y.6 '...... /. J Cit -----•.......... _....- _ p ate.. ....._.._..-__ y�.\ _ _... _- ------------ - - ------ -------/- Contractor's Name ....--- .��!�-�a- t• ... -- =- -•------------------..License# __l d d /f--..._ Phone .:/.G�."I`��Q. .. Installation will serve: Residence ❑ Apartment House❑ Commercial ❑Trailer Court C] Motel ❑Other Number of living units: ...... Number of bedrooms . ......Garbage Grinder _.. ------ Lot Size .............. ............. .. ...---.. Water Supply: Public System and name ------.. ..-- - ----------------- -------------------.r........... ....... ..... . -.Private Character of soil to ardepth of 3 feet: Sand Silt❑ Clay ❑ Peat❑ Sandy Loam N, Clay Loam 1 Hardpan ❑ Adobe ❑ Fill Material ............ If yes, type ............................ (Plot plan;lshowing size of lot,slocuttar5'of system i elation to wells, buildings, etc. must Ibe placed on reverse side.) j 1:11111. NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,l PACKAGE TREATMENTSize.SEPTIC TANK 1 ! �r [ ) ( _ 7 �--�-..�.---- - ------- -------- Liquid Depth ....�.Y-----••------ CapacityTVY.VO�(. Type _ - Material-CO-K No. Compartments .............- Distance�to nearest: Well -.246--7e ..................Foundation ....�..------------- LEA, `f'.._..._LEACHING LINE No. of Lines ........ ' . Le gTK of each line--------- ....... Total Length `Z6a........... ^... N !. rr • DR,i'v �1D 'D' Box �T ..... ........• ,(� 1_nearest._Well-��\ '-1041 ype Filler Mate�al�.��_____Depth Filter Material ..f.. ._ . . _ . . -- �Distance .... Foundation ./..�_. '..._..._. Property Line _.��__._._.`'f ..... (` 6fE4 Depth /p. i....... Diameter Numbe. .-__....._ - __ Rock Filled Yesk No .0b f S - .---.-.--.••-- •-----------_----Rock Size /Y tGK+r Water Table Depth iDistance to nearest: Well .!'rte -----------------Foundation __. Prop. Line ............ REPAIR/ADDITION(Prev. Sanitation Permit# ------\.:_._..-. _._.�_r,l�_,_ ..F Date ............................... .. ) d Septic Tank (Specify Requirements) ... ._... \'r! s:_�s�,a_.. -..._.. .._ . ............. ..... ....-_....... .._...._ !� VDispas Field (Specify Requirements __ __ .__ _ _ . ___ _ _ _ _ _ _ __ .I............. ................. • - ------------ ---- ---- .-------- ----- ---- ...---- ----------------------- I ------r----- •t---- - - _... J - . T... _.____•.___.. .. .._.._`_... . ._.. ....... .... t-(Dr''c 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 Ordiflainces,.State Laws,.and Rules-and-Regulations of-the Son,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 I as to become subject to Workman's Compensation laws of California." I Signed ..... ..---- Owner -------•------. -. By _... _...._. . .. ........ _ Title .. i.... ..... (if of er owner) ; FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ............ ---- ---........ ................. . DATE .......... `f BUILDINGPERMIT ISSUED .._.._. ....-•---•------•------_..-----...-•------•---.................................DATE ........................................... j ADDITIONALCOMMENTS ....w - _.........................._.............. ....-...........---............................. ... _-------------------_....-•- - -----•--------------......_-•--•---•--...._...• - ------- ..-........_..........--..................__........................................__ Final Inspection by: ----•---•-•---- -- ........---....Date ........................................... SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M