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..=..rte--'�*•...!"�-yT-J?�er+�n.rw.---��«.-.-�-'--mr .�••a-�+•.,.,,v-,� _. FOR OFFICE USE: APPLICATION ICOR ................. SANITATION PERMIT tCotapletein Triplicate), Permit No. ._� ._ .�_..- ..__...... .._........................... _ ... . _ This Permit fx fires >I Year I:rortt Date Issued'.........:.........•:.....__........_ Date Issued Application is hereby mcide to the San Joaquin Local Health District-for a permit'to i construct and install the work herein described. This opplicdtion is made in compliance with County Ordinance No. 549 and existing Rules and Regulations. I JOB ADDRES5/L©CATI N __. /^-- t ,_a, ...............................• . .........CENSUS TRACT .....---- � Owner's Name _ .......... _...._-- Address __._....._ _- �1 ........_ . . Cf �..... a�a�rx� Contractor's Norrie -- r .' ... se ` .._... 3.. 3. Ph _ -- one _ .: Installation will serve: Residence❑Apartment House El C mmercial❑Trailer Court ❑ Motel Q Other------ ...................� !..-----•----. .... y Number of livin units:...... Number of bedroomsO ,� t ... rbcge Grinder Size ...�5_l3__.?�._2:� Water Supply: Public System and nanie'i ................. r v.. k f. - 1 i ...,r _ i y. ..---• i _......... ._ ;'c Q!`• rS..t...........Private❑, o Character of soil to a depth of 3 feet: Sandti ilt Clay �� oY eat❑ Sandy Loom ❑. Clay Loam ❑ t.t ;- Hardpan[],4 Adobe Fill'MctteriotI ..}........ if yes,type•.............. ............ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc, must be placed on reverse side.! NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,} PACKAGE TREATMENT [ I SEPTIC TANK ] Size.__.... ._r.. . ...... .............................. Liquid Depth ------- Capacity -------_----•---- Tyke .............. Material_ I--.._....•---•--• No. Compartments Distance to nearest: Well _____._.__•._._ ..Foundation ...................... Prop Line LEACHING LINE [ ] No. of lines ---------------------- Length of eI do Eine--- ..__......_•____••._... Total Length. 'D' Box ............ Type Filter Material [Ak- ..____.Depth .Filter Material .. _..---•.......................r Distance to nearest: Well . ..__.---•----_-•... Foundation. ._._..... Property Line SEEPAGE PIT [ 9 Depth ------ ----- Diameter _.. Number ..__........................ Rock Filled Yes [I No C] . Water Table DepthiTo Rock Size ....... Distance to nearest: Well .......................... ...Foundation .____.. Prop. Line ` REPAIR/ADDITION lPrev. Sanitation Permit# Date ._ .............. _ • --- Septic Tank (Specify Requirements) ................................ Disposal Field (SpecifylRequirements) r Y I 1------ ---, _ --- •-•---•---•----••---•--------•--...-- .........-•-•--- ------------ --------------------------------------------••------------------------------------•-----------„------------.....- (Draw existing and required addition on'•everse side) I hereby certify that I have,prepared this application and that the work will be done in accordance with Sar Joaquin County Ordinances, State Law's, and Rules andRegulations of the San Joaquin Local Health;District, Home owner orlicew sed agents signature certifies the following: "I certify that In the performance of the work for which this permit is issued(-1 shall not employ any person in such manner as to become sub€ett to Workman's Compensation laws of California." Signed --- -----------i•----- ----- Owner .............•-•---•---.._-- By --------- - -- -------•••••------...._ title ....-- er than owner) FOR DEPART NT USE ONLY CATION ACCEPTED BY _-- - • ----- - -- - - - ........... - --. ...._ BUC DING PERMIT ISSUED DATE -- . --•--- -------••--•................__...-----••-----••-- DATE ... --...... ADDITIONAL COMMENTS ................... ....... - ....................... . .. ..........._.. ---•---------------- f•-------•-•---••-----------------•-----.....------•---•---••--------........_._ _, ------t --=----- i ---•---•- --•---• - -•------•---------•------------ ----•---- ------------ ---------------•........ ._... Final inspection b .................,.....----------- -- . p y: .. _Date _.. _.. .�- EH 13 2} �-b 8 Ree. 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M