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FOR OFFICE USE: , , .APPLICATI FCrk SANITATION PERMIT —�/3 ------------------------------ . .. . Permit No: --7----------- ----------------- --- - • (Complete in Triplicate) , --------------------------------------------------------- ----------------f_----------.__-------___-------__-__-- 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 Regulations: 4 J08 ,ADDRESS/LOCATION �`#= � _ _ 777i. c=i' __CE a Owner's Name ---------Phone � -------d- = Address --5 --q ' �C`= -�-r-------��'-��------------------- City --------------------------_.---------- Contractor's Name -/ .�-I�4.s_�_5---- �, ti-C -- ��v�-C ------- I---.License #161",5_1---- Phone Installation will serve:.,,, -Residence-[..Apartment House❑ Commercial:❑Trailer Court Motel ❑Other Number of living units:.-- ----- Number of bedrooms '_ -_-_:Garbage Grinder -__-_____.,- Lot Size -f __-�1---- �- r/ - ----------- Water Supply: Pub lic System and name .. ----- . -�1.1_� !-,__-Q,----------------------------------Private ❑ , Character of soil to a depth of 3 feet: Sand'❑ Silt❑: Clay X] Peat❑ Sandy Loam -❑ Clay Loam ❑ Hardpan ❑ Adobe E] Fill Material ------ ----- if yes, type - -------------------'-- �,,• 0 (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 permitted if public sewer is available within 200 feet,) _ t_ PACKAGE TREATMENT SEPTIC TANK Size-__ _t2A__ - -------- Liquid Depth - �'-------•----- . i Capacity 16�49A>� ype -,O _- a- _ _----- Material��_r�Lre� "� - No. Compartments ---_ --__-_-_- -` + :4� i Distance to _=777777--___t___--.Foundation ------ Prop. Line --_-�O'_,-•; k LEACHING LINE ( No. of Lines ____ ------ Length of each line-------90-------------- Total' Length ----------- 'D' Box _f__--_- Type Filter Material ---------- - __--.Depth Filter Material -----__ ---_-._.--___-_-_-__- �p-� Distance to nearest: Well -----------------.Foundation .--_-_/__Q--~------- Property Line.-- --_---:�^ SE��I`f Depth -�______ -Diameter , -- y - ----------------- Rock Filled Yes ® No .>C .� U(� P ----- X- - Number ' Water. Table Depth �f--�_-- ---------Rock Size -------------------- Distance to nearest: Well --------- -� 1 - -�----_---Foundation s-------A�- --- Prop. Line _--_ REPAIR/ADDITION(Prev. Sanitation Permit# ------------------------------------ ------- Date ------------------------ ) Septic T nk (Spec`ify Requirements) I - 4 - f Disposal Field (Specify Requirements) iC1 ----------- -- ------------------------ ------------------------------ r _ - ". ' --------------------------------------------- ---------------- --------=-------- ------------------------------ ' (Draw existing and required addition on reverse side) t '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 liven- 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 -- ------ = ---------------- Owner r Q � BY r —�. Title (If other than owner) t FOR DEPARTMENT USE ONLY f APPLICATION ACCEPTED BY --------------- DATE __---- ' - ----------------------------------- AT BUILDING-PERMIT ISSUED __-_- --- --_ >f- � f - - - --------- -- ------- ADDITIONAL COMMENTSCox= ---- - - ----------___- a� -------- -- ----------------------------------------------------------------------------------------------------------------------- - ---- � . --------- ---------------------------- :: --- --------- ----- - ----------------------------------------------------------------------------------- ------ ---- - ----- Final Inspection bY- f -- --- --- ---- Date '� J - --- SAN JOAQUIN LOC/4 HEALTH DISTRICT t E. H. 9 7-'68 Rev. 5M