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FOR OFFICE USE.- FOR SE:FOR OFFICE USE: APPLICATION TOR SANITATION PERMIT Permit No --- ---- -------------------------------- ---------------------------- ---- -------------- --------- (Complete in Triplicate) ----- / „?-�- ----- ------ ------ 7 ? ��'!" -- Date Issued_-.--- This Permit Expires 1 Year From Date Issued the Application is hereby made to the San Joaquin i County OrdinfianccesNo. 549 and existing Rulermit to truct and es and Regulations: work hereindescribed. This application is made in compliance w Y _ CENSUS TRACT...0 ------------ JOB ADDRESS/LOCATION-, -5— - Ph 1 r one.��8"'- Owner's Name._ _ �PA - . !�L ----------------- - .�. - - Zip------------------------------ Ad ------ ---- Address. --.---�.�/�.?�+�--- •� _ate -- - --- - CitY of .4lQ"�-------- Contractor's Name_. --------------------------- -- ----- --- --- -------------- - - - - --------.._License #--- ------ .......... -----Phone-------------- ---------------- -- Installation will serve: Residence° Apartment House.I] Commercial ❑ Trailer Court [Is Motel ❑ Other----------------- -------------------------`- Number of living units:-_.L_._____Number of bedrooms-.3 .._Garbage Grinder.--Lot Size._--- Private-----______- Water Supply: Public System and name------------------------- --- ---------------------- - Character of soil to a depth of 3 feet: Sand F1 Silt❑ Cloy ❑ Peat❑ Sandy Loam Clay Loam ❑ ' Hardpan ❑� Adobe ❑ Fill Material-. ---------If Yes, type--- ------=------------------- a (Plot plan, showing size of lot, location of system in relation to.wells, buildings, etc, must be placed on reversd side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,] Sizer341_J /� f "�f ` ----------Liquid Depth. SEPTIC TANK [ ] -- PACKAGE TREATMENT [ } Compartments_.--___. /�__> ----Matarial_�.� LTC 1S « Capacity�Iz TYpelrr Pro Line-- J .Distance to nearest: Well.------ ------------------------------------ Foundation p t Length of each line.. _ _��---------------.Total Length.----Z`7-------------- ---- LEACHING LINE [ l No. of Lines . ---- g 'D' Box_ -/-.---Type Filter Materiai.�- -*�-------- pepth Filter Material- ---r e -J Property Line ----- Foundation =} ' p tY �C3U-X -y Distance to nearest: Well______ -- `-' ' _Diumetar.- N ------------------------------ R 1&EAA6 f l �' •----------�,-- � r . - �e----- --- ---------------- Wa --------------------- .. ------------ s : e ---------------.: - ------------------------ 3 REPAIR/ADDITION (Prev. Sanitatio ...... ----------------------- - Date ] o - I , � Septic Tank (Specify Requirement _. . _�'��/ -- --��t,-;�yr�---S��'�.�'-'-`-"------------------------------------------�------------------- Septic - Disposal Field (Specify Requirements)_-- -._-- - -�� /Ri�� - ---.-- -'-a--- ��/��--� -•------------------ ------------------- . - .. �� -------- ------- ---------------------- -------------- --------- , (Draw existing and required addition on reverse si e 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 licensed 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.as I to become su ct to Workman's Compensation laws of California." I _ Owner Signed { ' 4 -- ----------- ........ Title---------- --------------- -------- ---=--------- --- ------- t (If other than owner) " 41PR DEPARTMENT USE ONLY f _ 1 �' - = DATE.--- Y ~ APPLICATION ACCEPTED By---- --- ._,_---- -- DATE----------------------- ----- ---------------- DIVISION ------- ----DIVISION OF LAND NUMBER ------- ---------------------------------------------- ------------------------ ----------------- ADDITIONAL COMMENT ________________________ - ---------------------------------------------- -.- = ____ -------- ----- --------------------------- --- -_-_-----------------------_=_==_ __=__=___=____ :_.___ __ _ --- ( Final Inspe-------------- :.. Dafie� 1 CtlOn by:" --- ----- F85 N677 REV. 7/76 3M EK 13 24 SAN JOAQU IN LOCAL HEALTH DISTRICT