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`FOR,0VICE USE: APPLICATION OOR SANITATION PERMIT -- --- -------------------------------- (Completein Triplicate) Permit No: Date Issued ______S. ---------- ----- ------------ ----__--_---------- e This Permit Expires.1 Year From Date Issued Application is hereby made to the San JoaquinLoocaal 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: D �___92-r VT- _C�ICENSUS TRACT ----------------------•- JOB ADDRESS/LOCAT -e 6 �J--- Owner's Name - -- ------- - ------------------ - ------------- -- - Phone _ `.7 .. Address - ------- ------------------- ------- __ Cityn----- ------------------------------------------------- Contractor's Name License #)iff�_7Y-3---- Phone�4_ _N4?1_------ Installation will serve: Residence Apartment House❑ Commercial :❑Trailer Court i❑ Motel ❑ Other-------------------------------------------- Number of living units:------ Number of bedrooms -_-___-3---Garbage Grinder ----__ _ ___ of Size _ /' -� --_______________ Water Supply: Public System and name ---------------------------------------------------------------------� -----------------Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe;'q Fill Material ------------ 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,) 4L1' 1 1 PACKAGE TREATMENT [ J SEPTIC TANK Size---------� __________________ Liquid Depth .. ...._._____.! Capacity - _ Type 4(� --- Material_ __ No./ Compartments _2� -- Distance to nearest: Well ___________________________________Foundation ----/d------------ Prop. Line __ /_iri______-_ LEACHING LINE [ No. of Lines --_____7/____:__ Length of eac line-------- - -----__ Total Length __/ -r-______ 9 Cr D' Box -----�-Type Filter Material __ _______________Depth Filter Material ____ -- r Distance to nearest: Well ________________________ Foundation ----rP---_---------- Property Line .......... t SEEPAGE PIT Depth ----- S___ ___ Diameter -------- Number .______.� ____.__---. Rock Filled Yes (K No i❑ t'r Water Table Depth ------------------------------------------------Rock Size ....... f f Distance to nearest: Well ----------------------------------------Foundation ----A)----'f`: Prop. Line ---c5...___.___.--_-- - REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------11 SepticTank (Specify Requirements) ----------------------------------------------------------------------------------•---------------------------•---------------------------- Disposal Field (Specify Requirements) ------------------------------- ----------------------------------------------------------------- ----------------------------------- -------------------- --- ---- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------- (Draw 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 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 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 subject to Workman's Compensation laws of California." Signed --------- ----- - - ------- - •--�-- - ------------------------------------------- Owner By ------------- - ` ---------------- ----------------------- Title -- - --------- ---------------------------------- (if -- --------------------------------------------- (If of r than owner) FOR_DEPARTMENT USE ONLY s APPLICATION A CEPTED BY .�. ?� -___ -_ DATE _ .. —__ ------- - ------------------------------- BUILDING PERMIT ISSUED .. v� DATE - -ADDITIONAL COMMENTS --- - ----- -- s 1�Irrrc�o - f/ ---------- ----------------------------------------- ---= ---- --- --- -v ----------------------------------------------- --------------------------------------- -------------------------------------------------------- ------------------------ ----- -------- --- -- - 5�------ FinalInspection by- ------------- ----- - - ---------- --- --- - ------ --- --- -- - ------- ---- ------------------._.Date -- --- ----- ------ SAN JOAQUIN OCAL HEALTH DISTRICT a E. H. 9 1-'68 Rev. 5M