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-FOR OFFICE USE: A P CAT t)73 SANIT�TION�PERMIT ��_e /gJ7y f ��-1/ Permit No. _.1_�_ .6e___.________ (Complete in Triplicate) --------------------------------------- �d ------------------ Date Issued ----- -------�--.. This Permit Expires 1 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 dinance No. 549 and existing Rules and Regulations: or JOB ADDRESS/LOCATION ._ - - __.._CENSUS TRACT -------------------------- -------- -___.__________________ Owner s Name - f -------Phon ------------------------------------ ----------------------- Address --- --- --�c ---- Cit " --------- ---------------•-------------- ---------- -- ,,� License # - Contractor's Name --- - i�-G----- ---- ------2;��------ --- 11,f c_ hon -- - --------.----------- Installation will serve: Residence partment House'Fl Commercial ❑Trailer Court ❑ Motel ❑Other -------------------------------------------- Number of living units:---- .------ Number of bedrooms ____Garbage Grinder,�W--- Lot Size -------------------------------------------- Water -______________ _-----------------------Water Supply: Public System and name ---------------------- ----------------------------------------Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt[I Gay ❑ Peat❑ Sandy Loam ,E] 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,) (� PACKAGE TREATMENT I ] SEPTIC TANK f 7 Size------------------------------------------ ----- Liquid Depth --------------------------- Capacity ------------------- --------------------.-----Ca acit _ 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 [ j Depth Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No Water Table Depth -----------Rock Size ------------------------------- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ------- _----------- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date -----___-___ _ ----------------- )W_ -.--- --1 r )W_ll_ --------------------- Septic Tank (Specify Requirements) --------: -"-- --- ,w `�-- ,q � bis sal Field (Sped ,j2e it ments) 10 ---- ---- - - {t� - - -------- - --- - -------- (DraGv existi g ncl required ad �- --- - ----------- r---- dition on reverse side) I hereby certi y 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 --- ...G�/�,-�- ---------------- ------------------ ---- Owner .. -------- BY Title If other than owner) FOR DEPARTMENT USE ONLY APP KATION ACCEPTED BY a ----------------- - -•------- DATE �� BUILDING PERMIT i55UED - DATE ------------ ADDITIONAL COMMENTS ------- - -------- - ---------------------------------=-----------------•----- ------------------------------------------------------------------------------- ---------------------------------- - --- -----------I------- Final Inspection by ------------ ------------------ - ------------------------------- -------------------------------------------------.Date ---- -------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M