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FOR OFFICE USE: � - .�;. APPLICATION FOR,f.SA;WATION PERMIT --------------- -------------------------------- (Complete in Triplicate) Permit No.7� -------------------- `N This Permit Expires 1 Year From Date Issued Date Issued __ - g___. 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: JOB ADDRESS/LOCATION .. �.�5 �-----�----1 ---------------------- CENSUS TRACT ----- - - ---------------- s Owner's Name - ----v-QJr C �3o ---------------------- - Phone - � ' Addressl --��t -----------•--- -------------------------------------- City --'0,)l------ ------------------- Contractor's Namel_,"_ )Q ____. _ -------License # --lL�: �5------ Phone ______________________________ Installation will serve: Residence&Apartment House-E] Commercial ❑Trailer Court i❑ n Motel ❑ Other -------------------- ------------------------ Number of living units;.... Number of bedrooms _Z_ ------ Grinder ------------ Lot Size �_NCr'2�_______________--- Water Supply: Public System and name -------------------------------------------------------------------------------------------------------------------Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ,❑ Clay Loam ❑ T 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.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTI TANK.) ]l Size----------------------------------------.------- Liquid Depth ---------------.-.-_______ Capacity ._ --------- -- ype _ __ __ ------ Material-QQc ___ No. Compartments &...._-_..�._._ i Distance to nearest: Well -k3D---__-----------------------Foundation _ I ------------- Prop. Line ----- LEACHING LINE [ ] No. of Lines -� --_____________ Length of each line--- _____.._____ Total Length - ! -..0 - --------------- // 'D' Box ---- . Type Filter Material _ __Depth Filter Material _-__-_18N____________________________ t Distance to nearest.. Well a� Well ____________ Foundation -_ 10_____-----_ Property Line -ISDN------------ SEEPAGE PIT [ ] Depth ---. ______ Diameter aty------ Number ------v'I-----------------14, Rock Filled YesX No C -� Water Table Depth ----koo-----------------------------------Rock Size _9__Y-------------------- Distance to nearest: Well ----------------------------------------Foundation ------------'-_---- Prop. Line ----------..--....---- REPAIR/ADDITION(Prev. Sanitation Permit# ------------------------------ '---------- Date --------------------------.__-____) Septic Tank (Specify Requirements) --------------------------- --- -----------------------------------------------------------_---------------------------- �. Disposal Field [Specify Requirements) ----------------- ---------------------------------------------------------------- ---------------- ------------- - (Draw existing and required cfddition-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 issued, I shall not employ any person in such manner as to become sublet Work compensation laws of California." Signed -- - -- `'�'-------------------------------- Owner r By ---------- --------------------------------------------------------------------------------- -Title ------- --------------------------------------------------- (If other than owner) FOR DEPARTME19T USE ONLY 4� APPLICATION ACCEPTED BY ----------------------------------- - ---. DATE v'1o�--------- ------- BUILDING PERMIT ISSUED -- 1nN�----------------------- ------------------------ DATE ADDITIONAL COMMENTS ---------------------------�--------------------------------------------------------------------------- ------------------------------------ w: -- \----------- i Final Inspection by: _ "�" ' � -----------------------------------------------------------------------Dat - -�--- e - --------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M