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' FOR OFFICE USE: `�-�1..........OFFICE FOR SANITATION PERMIT l ...c?.............. Permit No: ..7 ...._'3._3. (Complete in Triplicate) ............................... ............................. This Permit Expires I Year From Date Issued Date Issued Application is hereby made to the Son 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. 544 and existing Rules and Regulations: JOB ADDRESS/LOCATION ..................... ....................... TRACT TRACT .......................... i Owner's Name :.............. ,a1.9._....�.C� f .. ......................................... ._Phone ..j'��`.�� Address ------- ..................�.1 bvTll------........... ............ ......... City .101'40V i ............................. Contractor's Name ..... r. _.._ 4f ................................:......License # Phone- Installation honeInstallation will serve: Residence [g Apartment House Commercial ❑Trailer Court 0 Motel-0 Other .................................. ...... , Number of living units:------ ___-_ Number of bedrooms __..___.Garbage Grinder ............ Lot Size .Y > s Water Supply: Public System and name ...................................... ................•.......................................................Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ . Clay ❑ -Peat❑ Sandy Loam 0 Clay Loom ❑ I Hardpan ❑ Adobe 54 Fill Material --- ........ If yes, type ---------------------------- I r Q (Plot plan, showing size of lot, location,of system_in relation:to wells, buildings, etc. be' placed on reverse side.) h NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ) SEPTIC TANK T ] Size-............................................... Liquid Depth ..._..... ...I....... .--.. .. , t Capacity .................... Type •••.;...._•--_.... Material..........--•--------- No. 'Compartments ...................... Distance to nearest: Well-..................................... .............:......._ Prop. Line ...._........---._...- (h l LEACHING LINT~ [ ] No. of Lines .._:.__----t .. . Length of each line-------.___._. ......... Total Length ............................ 'D' Box .--=-=•__--• Type Filter Material ____________________Depth, filter Material ................-........................... y Distance to'neorest: Well.......:. . ..: . aundatior► ................... .... .Property Line ........:................. SEEPAGE PIT Depth ........... .Diameter Number......---------:............Rock Filled Yes [:]'. No ❑ Water Table Depth Rock Size Distance to nearest: Well •-----•"-•-. --Foundation,.................--- r line .... ' --=..---.. REPAIR/ADDITION(Prev. Sanitation Permit # :...•....:: .... ............ ---- Date .......................... f Septic Tank (Specify Requirements) 1/ .........'.._........ - --- Disposal Field (Specify Requirements}" ----------- ____________________________________________________________________ .. ___ ..!.r�... ._.........._.._ ._. ...___._.............__._.._.._ _.......... _ ____ (Draw existing and require'd'addi`tion on reverse side) t ".`{ w 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, 1 shall not employ any person In such manner _-�-.- -. as-to become subject to orkV.sompensaiton laws of CalI ornia." %EX -Sigried -:-- r.e., • . Owrser.___ _ ^' i 1 By __....... .................................... ................... :.......... title ..------------------...... ......... .__...--- ............ _ . (If other than owner) ._:_ _ - .I FOR DEPART ENT USE ONLY y— APPLICATION ACCEPTED B 1.... .......:. '.::::::...: .':... ... ....... DATE .. :�:... . :.. BUILDING PERMIT ISSUED ........................................ ----••••• _._.DATE .............. ADDITIONAL COMMENT T.-..-.-.-'---------.-.'. ........ I __ __ ................. . ......•-.._ . - . .. . `-_......__•_...'_---_.'p--T-'_..___. ....y.... _.._... ---------. . ............................ _ . ....... ............... .. ............... ... ................ . f Final Inspection by: ............. ._..__Date --•............................_.. _ _JOWN LOCAL HEALTH DISTRICT E. H.13 241-'68 Rev. 5 7/723M