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FOR OFFICE USE: APPLICATION TOR ANITATION PERMIT ��'--- ----�/'-�--- --3 Permit No. - ---------- ---- -- (Complete in Triplicate ---- ---------------- ---- ---------- --------- This Permit Expires 1 Year From Date Issued Date issued --�--y---7 --------- ---------------------------------------------- - 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/LO ON _XI-0---._G -i?� --/ CENSUS TRACT Owner's Name ---A.d_hFsG7 " Jam' � ---- ---Phone7 __ - -'rt��...SC.1i_Sl---------------- - Cit Y�C_� -----------------------------------•- ---•-- Address __ Y Contractor's Name ------------ License # -1Phone Installation will serve: Residence kApartment House❑ Commercial []Trailer Court ;❑ Motel ❑Other -------------------------------------------- at - Number of living units:-_C------- Number of bedrooms __�i____Garbage Grinder .___--_____ Lot Size ____ __�'_r�' riva �-----------•- - _____ --- - - -----•---- ----•---------Private Water Supply: Public System and name ______________________ ___ ---- Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam {] Clay Loam ❑ 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,) W PACKAGE TREATMENT [ SEPTIC TANK [ 1 Size- ---- Liquid Depth ----------- ---•---- GG Capacity _ Type -------------------- Material---------------------- No. Compartments -------------------•-- Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line ----------------_--- LEACHING LINE [ ] No. of Lines ------------------------ Length of each line---------------------------- Total Length ---------------------------- 'D' Box ------------ Type Filter Material --------------------Depth Filter Material ----------------------• Distance to nearest: Well --------_ ___ Foundation ------------------------ Property Line ___--------------------- SEEPAGE PIT [ ] Depth --- Number _-------/-------_____--__ Rock Filled Yes No IQ - Brerrreter r ---------••----Rock Size ----- Foundation --- Water Table Depth ____��____________________ � l r � Distance to nearest: Well _._f �------------ Foundation ---/0---------- Prop. Line ----- ----- - REPAIR/ADD171ON(Prev. Sanitation Permit# -------------------------------------------- Date __-______-------_-----._----------) Septic Tank (Specify Requirements) ----- ------------- ---------- -----•-------------------------------- o------ - --------- Disal Field (Specify 3equirements), -- •-------- ------•• --- -- --- - -------- -------------------- --- ----------•------------------------------------------------------------------------------------------------------------------------------- {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 becom Iect to Workma 's Co pensation laws of California." Signed __._ ------ -- ---- -- --------------- wner Title - -`----------------------------------- Ilf other than own r) FOR D PARTMENT USE ONLY APPLICATION ACCEPTED BY ------- - -- -- - -`----------------------------------------------- DATE ---- -- ---- -------------- BUILDING PERMIT ISSUED ------------------- -----DAT ------------------------------------------- ADDITIONALCOMMENTS ------- ---------------- ------------------------------------------------------------ -------------- ------- ---------------------- ------------------------------------------------------------------------------------------------------ --------------------- -------------------------------------------- Final -- .. Final Ins ection b _ Date --_-- --- ----- -- - �---- -- - --- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M