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FOR OFFICE USE: APPLICATION,-FOR SANITATION PERMIT ----------------- - ICp�tnpletEvtn Triplicate) Permit No. -_..__ -r_ --------------------------------------------------_ �,------ This Permit Expires i Year From Date Issued 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 application is made in compliance_with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ` VI/A-/,-T 1 JJt-a - - ! ------CENSUS TRACT ---- -.,i5 Owner's Name ------ � - tC s /� _._./ Q11(/+ fU ------------------- --Phone: , f} Address .__.�� -_ - - 5, /1 1, SPA Z---�7 211 --:. cit n- �14N TfC�_R-------------------- - Contractor's Name ------ hLfi4r C4�` ---�—.r-._ ------------License -: Phone ------------------------------------- Installation wili'serve. Residence 0-4artment House,0 Commercial :Trailer Court ',E] : Motel Other _:---------- _ yNumbi er/of livng units _ _ Number-of'bedrooms .____ G � rE GarbaLot Size -------------------------------------------- j Water Supply: Public System.-ani name .-,____--------------- - t__- " --------------------------------- Private '--Character of-soil to-a-depth-of3,feet. • Sancl B . Silt n"C-lay-0-;-...Peat-[]:�.$q.ndy,.Loam. El Ciay.Loam Hardpa 'El Ado Fill Material _- _ If yes,type ______-_____________-- - � Y' (Plot plan, showing size of lot,,location o' system in relation to wells, buildings, etc. must be placed on reverse side.) f NEW INSTALLATION: (No septic--tank or eepage pit permitted if public sewer is available within 20D feet,} i - PACKAGE TREATMENT [ ]' ;'SEPTIC TANK ' V% ] Size------------------- --------------- ------ Liquid Depth --.-----------•------.---. ` Capacity --------------- -- T Pe'�------ `--------- t � �y Material -_: No. Compartments _ _______________ - Distances to near-65-s- Well --------z�------------------------Foundati n ------------------'- Prap Line -----------I.-- --•-•- r._-. i LEACHING LINE [ ] No. of Lina--------- __- �,.w CLength of each line__-_"____ --- - ------------ Total Length ----------- -----...---- y � Box __ :;Fi t.�yier Material ____________________Depth Fil er Material ------------------------ i Distance to nearest Well -_______ - ---- - y e; _ � _ Foundation# -------- ---------- -- Property Line SEEPAGE PIT ` [ 1 Depth ------:-T- ----- _Diameter:4`- ------ Number -- -`--- --------- ----- Rock Filled Yes j] No .0 --------- ' Water Table Depth --------'_-_----_------- -------------Rock.Size ------------------------- ----- Distance to neares : Wel! ---------Foundat' ------------------ Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit ---------------- Date ------- ------------------------- IO Septic Tank (Specify Requirements} -------- ---------- ------ .. ? -------------------- -------�------------------------------------------------------•---------------------------- Disposal Field (S !St ES7 ecify, Requirements} (� � _-_ _~� t1 _ --f 619 ' 4�49_(RZJW=EE [_n = - 117ft!;;7�------- , r4 (Draw existing and required addition on reverse side) I hereby certify that i have prepared this application and that thework 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: 1 "I certify t at i the pe rmance of the work for which this permit is issued,I shall not employ any person in such manner r as to be a ject orkman's`Compensation laws of California." i Signed {Owner i Q5-- 7y- -----------------------------------T By -------------- -------------- ---------- -----------------------------,-f `J ------- Title -------- (If other than owner) i FOR DEPARTMENT USE OY APPLICATION ACCEPTED BY _--- Lr------------------------------ ' -----. DATE _._. "^. .`-7 BUILDING PERMIT ISSUED -_!------- - - --- ADDITIONAL COMMENT --------------------------------------- 1---------•--- --------DATE ----- - - = ---------- ----- --. - -------- ---------------------- ------ ----- -- -- - Final Inspectio GrL/._ ---- --------- ---- - -- ------------.Dae - - / ---- ----------- SAN 'J-OAQUI.N_LO_CAL-HGAL .�!D.1STRiCT E. H. 9 1-'6$ Rev. 5M