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r FOR OFFICE USE: q•,3D APPLICATION `ICOR SANITATION PERMIT Permit No. .--_-------- - -------------------- ---------------------------------- (Complete in Triplicate) ---------=----------- -------- ------------------- --- Date Issued This Permit Expires 'I 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: -- ---CENSUS TRACT JOB ADDRESS/LOCATION __�DA-f�----- �----- ��Ty-.-- -W------ -------- --~-- ------------------ ------- Owner's Name -----�U1}�-------� Q �= �----------------------------------------------------- -------Phone Address ---- ----A/ - � �1_Q�` ------------ ' City �7 p�' --------------------------- ------------•- ��-� I.7. -�a y� --- Contractor's Name -----I�.�-�- ---sS��'-- ---,-------------------------- .License # - - Phone- Installation will serve: Residence [Apartment House'❑ Commercial ❑Trafier Court 'El. -Mote l- -Motei ❑Other ------------------- - ---------------------- Number of living units------ ------ Number of bedrooms .____-_ __.Garbage Grinder --��_ .. Lot Size Water Supply: Public System and name --------------------------------- •----------- - - - ------------------------- Private ❑ • Character of soil to d deptof 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam r] 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,) SEPTIC TANK' Size --- Liquid Depth -------------------------- PACKAGE TREATMENT [ [ l P Ca acit TYPe - ----- Material.-------------------- No. Compartments --------------•• PY -- ---------------- Distance to nearest: Well -------------- Foundation ------------------- Prop. Line Length of each line-------------- ------ ------ Total Length ------.-----•---------••- LEACHING LINE [ ] No. of Lines _---.-__-_-.---- g De th Filter Material ---------------------- ---;,---------------- `D' Box --____----- Type f=ilter Material ---------------- P { Foundation ------------------------ Property Line Distance to nearest: Well -------------------- SEEPAGE PIT [ ] Depth -_- Diameter ---------------- Number .__-__.-.__.__-_..._--______ Rock Filled Yes Cl No I❑ . — Water Table Depth ------------------------------------------ -----Rock Size------------------------------ Distance to nearest: Well ------------------------------------------- ---Foundation -------------------- Prop.___-.___ Line ------------------- ' - --------------------- Date -------------------- •------------! REPAIR./ADDITION(Prev. Sanitation Permit�# _._..__..-- - Septic Tank (Specify Requirements) --------------------------------- ---------------- - ------------- ---- ------- ----- -- Disposal Field (Specify Requirements) ---.-----��0-- ----41 �1/i/. r /�YY/J " 3------------ --�� -------------------=------------------------ -----------------S�' �� ----------------------------------------------------------------------- ---------------------------------------------------------------- -------------------------------------- ------------------------------------------- (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: "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 subject to Wor/rnan'spensation laws of California." Signed ---------- --- ---------------- -------------- Owner ----------------- ---------- Title ------------------------------------------------------------------------ (If other than FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ___ ---. -- ----------------------------------- DATE _. BUILDING PERMIT ISSUED ----------------------------- ------------------------- ------------------------------------- ---------- --------- --DATE ------------------------------------------ ADDITIONAL COMMENTS ------------- ------------ ------------------------------ -------------------------------------------------- ----------- ----------------------------------------------------- . -- --------•---- - - ---- -- - -- - - -------------- -------- --------- --------- ------- -- --- ----- - ------- ---- -- - ------- ----------------------------- - --- -.Date Final Inspection b SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.