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FOR OFFICE USE: • APPLICATION-.FCS SANITATION PERMIT -- Permit No. I (Complete in Triplicate) ' Date Issued _` � ----------- = -a =� ----711 3.U_'-------._. This Permit Expires 1 Year from Date Issued 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/LOCATION - -- / - ,---�� x �---------------------- ------CENSUS TRACT ------------------------.- Owner's Name -------- _0_1--------------------------------------------------- ---------------------------Phone -------------------------------•---- Address �f- City ------------------------------------------ Contractor's Name ---�tq-�-`� � � ---------------------------------License # --------- - ---- Phone ------------------------- Installation will serve: Residence ❑ Apartment House❑ Commercial ❑Trailer G bvi- Motel ❑ Other -------------------------- ----------------- Number of living units:.-/----- Number of bedrooms _.-----Garbage Grinder 1_41e_ Lot Size ____________---- Water Supply: Public System and name RIV_"_ _ f' l _ _-____Private ❑ 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 ___-_._____________-____(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,} V PACKAGE TREATMENT [ ] SEPTIC TANK'[4r, Sizemo ____ ----------- Liquid Depth Ca acity Ir------ Type v Material ' ___ No. Compartments ` '_.._.._...__ � • Distance to nearest: Well _ '______ _—'--------------Foundation _Xcl---___-_--___ Prop. Line ......... LEACHING LINE � No, of Lines ----/--------------- Length of each line--�� '-----.____ Total Length 'D' Box IVa -- Type Filter Material --Depth Filter Material " _---------_.............____...... ___----_- Foundation � Distance to nearest: Well _________�-�^� ; _ n� _____-____-- Property Line -Xil---------- e PIT JK Depth - � �----- Diameter � '�-. Number ----- ----------------- Rock Filled Yes No i❑ Water Table Depth ------- _r �� .�-`----------------- -- ----------Rock Size �--Y'--�---------- r Distance to nearest: Well _________-----------_,--_____ r�� -----____--Foundation ---- ------------- Prop. Line --_----- REPAIRJADDITION(Prev. Sanitation Permit# ----------------- -------_------------------ Date ----------------------------------) # Septic Tank (Specify Requirements) ----------------------------- ---------------------------------------------------- ---••---------------------+•---- i Disposal Field (Specify Requirements) --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------- --------------------------------------- "'"---" (Draw existing and required addition'on reverse side) I hereby'�cerfiify.that.1.have prepared, application.,and hat4he work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations off 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, l shall not employ any person in such manner as to become.:subject to Workman's Compensation laws of California." Signed 4ot � --- -- -------- Owner - --- --------------------- an ownerBy ------------------- -Tit / a h ' .r � O .DEPARTMENT USE ONLY APPLICATION ACCEPTED. BY ._ --.? - .�. - - ,--�' - -------------------------- -----------------------_. DATE _ rf BUILDING PERMIT ISSUED!._-!A.___'__ A-____ / --- --------------DATE ------------------------------------------ ADNT.ION,gL C E TS—' s I _ r it '� �S { lfhA.=' a" � / { { t/ �' �s ---- ------ ' 'modal �' ct Finl� nspection by: - ----------------------- ------ --------------------------------------- ate --- ---- - ---------------- r �S: J UIN LOCAL HEA I�T H DISTRICT E. H. 9 1- 68 Rev.