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FOR OFFICE USE: APPLICATIOW IFOR°SANITATION PERMIT Permit No: ��•---��-�U- (Complete'sn Triplicate) --------------------------------- ----------------------- Date Issued This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: fa 0 .706 ADDRESS/LOCATION "" TRACT ._____.__ _�------ ---------- --- - - ��,I --------Phone _�" Owner's Name �!/�=--- --s--- - ---- - --- ---- ----- ----- ------------------•---------- --- Address ----- - Q City ` -- ----------------------------------- �. " ._ � __ Phone - ----- -� ¢ - Contractor's Name ------ --- -------------------- -- - - ------ --------- - License # ; Installation will serve: Residence' &partment House❑ Commercial :❑7rai.ler Court ❑ ;❑ h T Motel Other------------------------------------------ '` ;,: T' j � f Number of living units:__--1-___.- Number,ofa:bedrooms __ _ _Garbage Grind ____-- _ Lot Size 5------- -�`-ego----------•---- ' y _______Private E]Water Supply: Public System and name ------------------------------------------- Character of soil to a depth of 3 feet: Sand-C]. 4,,Silt M, -Clay E] Peat ❑ Sandy,Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe'( Fill Material __ ------ If yes, type ____________________________ (Plot plan, showing size of lot, location of system in relation to wells, buildings,ketc. .must be placed on reverse side.) Q NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT ( ] SEPTIC IG TANK [ ]' Size ------------• - ----'----- ------ -- - - WLiquidDepth Ca acitY ----- Material---:-T_7 No`-Compartments ---7--------••--...... ------- ----------- ype ---- Distance to nearest: Well' --_-- -_--------------------------Foundation ----------------- -- Prop. Line LEACHING LINE ] No. of Lines : ------- Length of each line---_----------------------- Total' Length -----------.---------------- 'D' Box ------------ Type Filter Material --------------------Depth Filter Material _ ` .. --- Property Line. ------------------------ Distance to .nearest: ell -------------- - _ "Foundation P tY SEEPAGE PIT [ ] Depth _---_ Rock Filled Yes No Q .----------- Diameter Number - 0 WaterTable Depth ------------------------------------------------Rock Size ---------------------------- --- f Distance to nearest: Well ------------------------------�------- Foundation ----------------- Prop. Line ------------•--------• REPAIR ADDITION(Prev. Sanitation Permit�# ---------------- __--- Date ____-_--____-__ --------------- I ------------=------------------------------------------ Septic Tank (Specify Requirements} x - Disposal Field (Specify Requirements) --- --- r ------f___}-------A----" " " """""" ----------------- -- --------------------- , _—. . -- ------ --------- (Draw e)flsting-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 issuer), t shah not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed Owner ------ --------- -- BY ------------- --- --- - Title ------ ---------------------------------------------- (if of r han owner) FOR -DEPARTMENT USE ONLY, - - DATE - = T ---•-- APPLICATION ACCEPTED BY -=--�'�"- '--,�a.��/a-�-�=--==='==='----=--�=--_.�"--------- . ��---------- BUILDING PERMIT ISSUED -------- _ .. T -:— ADDITIONAL COMMENTS -------- *. - ------------------------------------------------------------- ---- ------- ------- - ---- -- - ---- D '-- ate -------- Final Inspection b �SA�JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M