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FOR OFFICE USE: APPLICATION .r--OR SANITATION PERMIT _ . ��. (Complete in Triplicate) -r"" Permit Na. __.____----------!�_____ This Permit Expires 1 Year From Date Issued 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 Regulatipns: ei JOB ADDRESS/LOC`ATION.��_:i _:Lr------ -i� '-- D�_' 1W- - ------ --- RSDS TRACT r-------------•--------- Owner's Name ./ _s l L�/t�ij "� -------------------------------- ------------------ Phone Address __5:7-657-------- /c/?P G� a� :City ---- - /---..... Contractor's Name � rr�� License#,:;2 Phone -d-x "Z�_i / Installation will serve: Residence(Apartment House❑ Commercial:[]Trailer Court',❑ Motel ❑ Other '4 Number of living units:----- ------ Number of bedroorns -----Garbage Grinder ------------ Lot Size f7�� _.••-_ Water Supply: Public System and name ____________________________ __.._Private ❑ Character of soil to a depth sof 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam Clay Loam.F] Hardpan ❑ Adobe ❑ Fill Material ------------ If yes, type __________________________ (Pl'ot 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,) �1 PACKAGE TREATMENT - ( ] I� SEPTIC TANK Size------------------------------------------------ Liquid Depth -------------------------- Ca adty -- -- --------------- Capacity --------------------- Type -------------------- Material---------------------- No. Compartments ------•----_ ------- Distance to nearest. Well --------------------------•---------Foundation ---------------------- Prop. Line ----------___,-_-_-_-- LEACHING LINE [ ] No.� of Lines ------ _--_ �______.__�_ Length of each line -Q ---_- Total Length -_''-'�'�-��--.� D' ''Box -____.------ Type Filter Material _� OCA_Depth Filter Material _-f-9_ _______________ 01 Distance to nearest: Well _____ __ ____ Foundation ` U 71 ----- -- ---------- Property Line ��-----•---•-_-- SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No iQ II Water Table Depth ------------------------------------------------Rock Size Distance to nearest: Weil -------------------•----------••--------Foundation -------------------- Prop. Line --------- ------- ll REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date Septic Tank (Specify Requ�irements) ------------------------- ----- Disposal Field S cif Require encs} _. C-/-_ 7�. Cl4 / ✓ - �y,C :. , -------------------------------------------------------------- ------- ----(Draw existing and requires dc3` ition on reverse side) 1 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, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed --- -- ----- -- ------------II ------ Owner BY ---�---- --A- -- ---- --- --- - --- ---------- Title ----------------------- (If other than owner) FOR DEPARTMENT USE ONLY 1 APPLICATION ACCEPTED B ------ -------------- DATE ---- '�� --------------------------- BUILDING PERMIT ISSUED - A-----------------------------------------------.- ---------"�---------------------- --------------DATE -- ADDITIONAL COMMENTS ---- - i ------------------------------------------ -------------- - - ----------------------------------- --------------------------------------------------------------------- ------------------------------- ' ,. ------------------------------ Inspection by: ---_---- - ------------Date __. ----- -------= Fina �I �- �IfIV�J AQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M