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F R_0F,FICE USE: $'w -. FOR SANITATION PERMIT t ---------------------- --- Permit No. (Complete in Triplicate) ------------------------------------------------------ Date Issued -:4--Ly _ ----- ------------- -_------------------------_ This Permit Expires 1 Year From Date Issued 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 ADDRESS/LOCATION ....... 35 ~-c----------- --- ---- --------I---------------------------------------CENSUS TRACT -------------------------- Owner's Name ------------------------------------------------------Phone Address _-ems' y'� `� -1 -- city --------------- � ------------------------ Contractor's Name ----- - ----------------------------------------------License # -6 '`�7 Phone Installation will serve: Residence L� Apartment House❑ Commercial ❑Trailer Court ;❑ - M Motel ❑Other -------------------------------------- Number of living units:__ _ ----- Number of bedrooms ----- Grinder ___-- Lot Size -------- Water ______Water Supply: Public System and name -----------------4--------------•-----' ------------------------- ------------------------------------•-----Private V Character of soil to a depth of 3 feet: Sand'E] Sift❑ Clay ] Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ AdobeW Fill Material ___________ If yes,type ---------------------------- (Plot --------------- -(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 [ I SEPTIC TANK:[ ] Size------------------------------------------------ Liquid Depth -------------------------- W 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 _______ ------------ SEEPA19L-PIT [ I Depth ___._f-6--11____ Diameter/__,kX/9�-_'Number ._______-_/-_.__-__-__-_ Rock Filled Yes � No Water Table Depth ----------------7 ------------------- Rock Size.- ---------- --------- Distance to nearest: Wel! ------- � - ------- -- -----------------Foundation ______`d--r- Prop. Line - -�.__......__ REPAHR �DT Prev. Sanitation Permit# -------------------------------------------- Date ---- -----------------------------1 Septic Tank (Specify Requirements) ---------------------------------------------------------------- Disposal Field (Specify Requirements) ---------- � ... �1 { - --------------------------------------------------------------------------------------- (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 Workman's Compensation laws of California." Signed ---------------a---------------- ---------- -- -----------------------/J Owner BY ---------- --- ------------------ ------ ---- Title --- -- (If other than-owner) Yep DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --- -4- ///--------------------------•----------------------------------------- DATE -- -- "/ -- ----- ---- - __....&UILDING PERMIT ISSUED --------------- ---------4- ----- ------------------------------------------------------ ----------- --DATE ------------------------------------------- ADDITIONALCOMMENTS ------------------------------------------------------------------------------------------------------- -------------------------- ---------- ------- ----------------------------------------------------------------------------------------------------- ----------------------------------------------------•------------------------ ------------ ---------=-Y-:-------- ------- Final Inspect b - ✓ - Date 3 20�UIN LOCAL HEALTH DISTRICT E. H. 9 -1-'68 Rev. 5M