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F R OFFICE USE: APPLICATION .011 .5- ►NITATION PERMIT .Iff ' ---- -------------p------ --------------- ----------------- Permit No. 3� 6 II�: � � , -„ � (Complete in Triplicate) -- --------------------- v Date Issued .-- __�5`-- ---------------- ! -------_-------- -----__- ----- This Permit Expires 1 Year From Date Issued r 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: JOB, DDRESS/LOCATION _-/-_�_ _y�-- -- -------- - ----- CENSUS TRACT -------------- Owner's Name _ / Phone %� ------ /2/'r ---------- ir _, - _-= Address ---- l- 1 y-------------------------------- City ------------------- --------------------------e-------- If -`r� --------------I------ Cont actor's Name _ i'� -------------------------------------------------------------------License # ----- ---,-------------- Phone --- -- ----------�----_---Installotion will serve: Residence ❑ Apartment House❑ Commercial,�PTrailer as t ;❑ I Motel ❑Other -------------------------------------------- Number of living units:.---/------ Number of bedrooms ---- ---_-Garbage Grinder ------------ Lot Size --- 3_�-------------------------- Jl' Water Supply: Public System and name --------------------------------------------------=------------------------------------------------------------Private'© Chc cter of soil to a depth-of 3 feet: -Sand'❑ Silt❑ Clay ❑ Peat 0 --Sandy-Loarh Cldy,Loam`:❑ "- Hardpan ❑ Adobe ❑ Fill Material ------------ If yes, type ---------------------------- (Plot plan, ---------------------------(Plotplan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) ! NEWIIiINSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) , / SEPTIC TANK Size- "f � `� ------------ Liquid Depth ---- /------------ - \\ PACKAGE TREATMENT { ] ] a Capacity,��_�------ TYpe/_-`---C'-"- Material----6-ry----"-- No. Compartments ---------------------- Distance to nearest: Well - =I ----------------------Foundation J-6-------------- Prop. Line __ --_-..------•.-- LEACHING LINE GJ No. of Lines --- ------------------ Length of each line----�Ra--------------- Total Length -�_ U---__-----.-- 'D' Box "'E"___ Type Filter Material -, '_- --------Depth Filter Material _-_ _9------------------------ ------ Distance - ---------------•------------- Distance to nearest: Well ------------------------ Foundation ------------------------ Property Line ------------------------ SEEPAGE PIT [ ] Depth __.--- -------- Diameter _-------------- Number _____.____._-- Rock Filled Yes 'E] No k WaterTable Depth ------------------------------------------------Rock Size ------------------------- Distance to nearest: Well ----------------------------------------Foundation --------------------- Prop. Line _---------_-_-_.-.---. REPAIR/ADDITION(Prev. Sanitation Permit# -------- ----------------------------------- Date ----------------------------------} Sptic Tank (Specify Requirements) ---------------------------------------------------------------------------------------------------------------- Disposal Field (Specify Requirements) ------------ ------------------------------------------------------------------------------------- ------- �! ----------- ------ --------------------------- -------------------------------------------------------------- - _ - V ------------- if (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: l "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 becom subject to Workman's Compensation laws of California." Signed ----` � --------------------------- Owner BY -- -------------------------------- ----------------------------------------- ------------------------- Title --------- ----------------------------------------- ------------------- - (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _. _ ------ -- ------ 7` DATE _ ' BUILDINGPERMIT ISSUED ------------------- --------------------------------------------- --------......DATE -----------•---------------------------- ADDITIONALCOMMENTS ----------------------- -----------------------------------------------------------------•---------------- i ------------------------------------------------------- --------------------------------------------- ----------- ----------------------------------------------- ------------ �1--------------- ------------------- - ---------------- > --..-:.r --------------------------------------------------------------------------------------- ---------------------- - --------------- ------------- Fin ------------ FinaInspection by; - -------- Date - ---- -�------ - ----------------- - ---------------------- ---------------- -?------------- --- SAN JO QU N LOCAL HEALTH DISTRICT - P E. H! 9 1-'68 Rev. 5M.