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FOR OFFICE USE: qp ICAT��I�pOR SANITATION PERMIT -.-....•....... ... Permit No. . ....... (Complete In Triplicate) ..•..•----.._..--•-••........................•-•-----•-•- This Permit Expires it Year From Date issued Date issued Application is hereby made to the San Joaquin focal 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/LOC CENSUS TRACT Owner's Name ..................................•---•••. ............ Phone �4,.9-n.� 7. Address ... tis :.. ...l l..... �_�ep.,e _f .................---•. City . ........ .e4..� ........................................ Contractor's Name ....................... .............. ........... .....................................License # ........................ Phone .............................. Installation will serve: Residence MI/Apartment House❑ Commercial❑Troller Court ❑ / Motel ❑Other . ....�../. ------------------ *........ /p� Number of living units:...,_---.- Number of bedrooms ----:7......Garbage Grinder ------------ Lot Si;e .../--.P--t-1 r7 AC.............. Water Supply: Public System and name ....... ----•---•--•..................------•----••----.........._..........--..............................Private f� . Character of soil too depth of 3 feet: Sand t3 Silt❑ Clay ❑ Peat❑ Sandy Loam f Clay Loam ❑ Hardpan❑ Adobe❑ 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.) l 1 NEW INSTALLATION: (No Aic tank or seepage pit permitted if public sewer is available within 200 feet,) TREATMENT SEPTIC TANK I ] Size.......................-.............----------- Liquid Depth .......................... � _ GE Ca aci /_ a'14 41-Type - Material...................... No. Compartments ...................... Distance to nearest: Well 1_.S_...0.:..... ...........Foundation -----/Al /------ Prop. Line ./.9.� N LEACHING LINE f j No. of Lines ------:.----------- Length of each line......YQ_.1........... Total Length .-----lc _ -�.... rr D' Box ...... Type Filter Material ... a th Filter Material .......................•. Distance to nearest: Well .... d.. ...... Foundation .....C2,7._....... Property Line ...... SEEPAGE PIT �� {r { j Depth ---a.�------------- Diameter .:y�..------ Number ._-...�----....._..... Rock Filled Yes R/ No ❑ ..�..... i Water Table Depth .........._pp 1�----------------•...............Rock Size c2. ....... Distance to nearest: Well ....s�� ---------------------Foundation ._._. ...... Prop. Line REPAIR/ADDITION(Prey. Sanitation Permit# ......•------------------------------------- Date ..........................4...... .) 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:Disiriet. Ham* 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 shalt not employ any person In such manner as to became subioct to o 9Compensation laws of California." Signed --- ----------------------- -- Owner By --------------------------------------------------------------------------------•-- Title _..... (if other than owner) OR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----- DATE BUILDING PERMIT ISSUED ...... -••-•---------- - ------ •---- ---------•--....._ . . -------- DATE ............. --------------------- A ADDITIONAL COMMENTS ................... ............ - :... ..................................._._..._..............._---_____.-....--------------.------•-•---------- ------------------ .......... ......................................................... ------------------.-------•----------------------------------------------- .------------------------------ . -._.____----•---.-- ........................................................... ....... ............................................................. .._.____.....- ._...�.. _ Final Inspection by- --------------- �..:._�_.__.----- .. ' ............ ©ate ... ..-.. EH 13 24 1-68 Rev. �i � ------------ -- SAN .l A IN LOCAL HEALTH DISTRICT $I']h 3M