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FOR OFFICE USE: APPLICATION$N'06'R SANITATION PERMIT r . .;sem Permit No. .-.7-3`--- -- [Comp leteitt'1rs p licate) Date Issued ---------------------------------------------------------- This Permit Expires 1 Year From Date Issued - Application is hereby made to the San Joaquin Local 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: �f G�% ----------CENSUS TRACT -------- ----------------- JOB ADDRESS/LOC ON __/4007 _ -------Phone Owner's Name ----osrtEs �- ---- --/�---------------- ---------------------------- �--------- ---�-------- -- --------------------- ---- Address ----------------4�a_.Sr_-------- -------------------------•--. City - License # ------------------- Phone Contractor's Name _-Z---- Installation will serve: Residence +partment House❑ Commercial ❑Trailer Court i0. Motel ❑Other -------------------------------------------- Number of living units_ Number of bedrooms ________-___Garbage Grinder -___ ------- Lot Size -------------------------------------------- Water Supply: Public System and name __________________ ------------- ------------------------------------------------------ Private ❑ - ------•---------- Character of soil to a depth of 3 feet- Sand' Silt❑ Clay ❑ Peat❑ Sandy Loam .E] Clay Loam ❑ Fill Material ------------ If yes, type ---------------------------- (Plot ------------------- ---- " Hardpan ❑ Adobe ❑ "T (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,) Size-------------- Liquid Depth ----- ! PACKAGE TREATMENT I ] SEPTIC TANK'S-� ---- -- -------- _ -___ Material No. Compartments _______________•---.- Capacity f_Zl1C1"""- --- TYPE--;-- - " } F r Distance to nearest: Well-- �--------------------- -Foundation :---�------------- Prop. Line ---------_=-�--- Length of each line---------------------------- Total Length _-�---- .EEAG ING I-WE [ No. of Lines / Depth Filter' Material A-b! ��f P �. 'D' Box .____._ -- Type Filter Materia _________-- " _-- -- k � 1 1 Foundation Property"Line --•-•-• Distance to nearest: Well _________________ - ---------------- SEEPAGE PIT [ ] Depth t Diameter __ - ------ Number ---------------------------- Rock Filled Yes ElNo ❑ 11-- - Water,Tabie Depth ------------------------------------ -----------Rock Size -------------------------------- V --------------------_--_ Prop. Line _____________________ Distance to nearest: Well ---------------------------------------- ! REPAIR/ADDITION(Prev. Sanitation Permit# "--"- Date-.. ----i---- -' ) --------------------------- Septic Tank (Specify Requirements) ---------- --- Disposal Field (Specify Requirements) -- --------------------------"""---"""""---_ ------------------------------------- - - ------------------------- ---------------------------------------------------------------- --------------- - i ------------------------------------- -- - - ' `' _" =-------------------------------------------------------------------------- = (Draw existing and required addition on reverse side) I hereby certify that 1`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 LocaO Health District. Home owner or licen- sed agents signature certifies the following: _-Ar4 r i "I certify that in the performance of the work-for which this permit=W_,,Hssued, I shall not employ any person in such manner as to bec subject to Workman's C :penscittan laws f California." -T Owner Signed ------- -- - F BY ------------------------------------------ --------------- --------------------------------------- -- ----- ------------ Title ------------------------ --- ------------------------- (If other than owner) FOR .DEPARTMENT USE ONLY DATE -------- --------- ---------- APPLICATION ACCEPTED BY --------- ------:- ----- -- - - - - --------------------------- ------- --- ----------- - BUILDING PERMIT ISSUED _:__-- 4=--=-------------- -- - — = ------ DATE-.- -:_::_._ .: __--------- -------------- ADDITIONAL COMMENTS ---------------- ------------------------------------------------------------ - -- ------------------- -------------------- ----- - -- ------------------ leg Final Inspection 6 "" """" zl SAN JOAQUIN LOCAL HEALTH DISTRICT a �. lk E. H. 9 1-'68 Rev. 5M