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FOR OFFICE USE: APPLICATION FCIR SANITATION PERMIT ' S- �G y _.... Permit No. .................. (Complete in Triplicate) ................_...._..__..._.._........._.......--•-- This Permit Expires.i Year From Date Issued Date Issued .Z2e.-— 7- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein a described, This application is mode in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ARDRE5S/LOCAT 4N �4.=t7��. .�... . ..... ... ..•-•- _. ._ .. ...'._....._... CENSUS TRACT ............... Owner's Name . . .�. .,. ... ........... .. Phone _...... ---------------- -------•-- ::.. . Address .._.. City _ . : ... ... License lPy3 . .. Contractor's Name.. :. ... =. # - --.- -- hone ::... Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court,❑ ' Motel ❑Other ........................................ , j !I Number of living units:........- . Number of bedrooms -....Garbage Grinder ------------ Lot Size ....... Water Supply: �ublic System and name ...................•-----•---------------•---....... ................ .......................-.................Private Character of soil to a depth of 3 feet: Sand❑ ilt❑ Clay ❑ Pegt❑ Sandy Loam I-] ClayLoam C] ardpan 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.] NEW INSTALLATION: i (No septic tank ore 1-ge pit permitted if public sewer is available within 20.0 feet,) :4- f PACKAGE TREATMENT [ ] SEPTIC TANKse ;r Size .-- _ :�-.X.,-� . Liquid Depth ....4................... Capacity _� -o_ C�.... Type - Material___ - . o. Compartments Distance to nearest: Well ....... ...... .t2........... Prop. Line ................. V # a LEACHING LINE [ No. of Lines ----:�-5------------- Length of each line----- `--�-a--r---------. Total Length ..--.-- 'D' Box ........I..`Type FilterMaterial `..'51Z_-.:-Depth Filter Material ...........t.4 -1r........... ........:... Distance to nearest: Well.......... Foundation ...1.`C . .......... Property, Line __ ....... k SEEPAGE PIT [ Depth _.__. _ Diameter .... Number ........-5............:..... Rock Filled Yes No [] Water Table Depth ......-•__-.I...Rock Size L �! ......:... Distance to nearest: Well ...... Foundation ......1.Q.. Prop. Line REPAIR ADDITION Prev. Sanitation Permit ql Date s Septic Tank (Specify Requirements),.-------------------.,...........-----.............. ...... -•...................... Disposal Field (Specify Requirements) ..................................':............................:.....-.-...............................,..............------------. �! i ........................•...............----------------------------------------------------------------..._.-•-----•-----------•----•-•-----.........---............... ................................ (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 1Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following:. f "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 Compensatlon laws of California." Signed .-------------------------- = . -- .................. Owner By -------------------------------- tie ....X-0 ----- {If other than owner) g x FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ... - DATE .,1.�?..'��...7T -- -------------. ... BUILDING PERMIT ISSUED --------------------------=--------- . ....-•-------•------•---•---.......-•-•••.. ADDITIONALCOMMENTS ... ................. ...............---..................-•-------•••----•------......---------------------._..... ..._........I...•---.....---•--•-------- ....................................... .,%l: .f•.......................................... rf! ----- ::....:::. ........... ........... .. .... •................ Final Inspection by: ---:..;� . ............. -..: Date :........ : ...................... SAN JOAQUIN LOCAL' HEALTH DISTRICT E. H.13 241-'b8 Rev. 5M 7/72 3 M P