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FOR OFFICE USE: FOR FOR SANITATION PERMIT ---------------- - ._.....--•-•-•---_- -- Permit Na. �D . (Complete in Triplicate) Date Issued .-`..f: ....;7� ....................:.. �y This Permit Expires ? %ear 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 Ordinance No. 549 and existing Rules and Regulations: JOB ADD 4 ...............................CENSUS TRACT . ........................ KESS/LOCATION .._...�._ .��_..�.:�.......�.�.�/.I��.�...�/.�. Owner's ,Name ... '1 ......�C�.__...._.... / .1 . Phone "'� Z. Address :......3r. = .........................................:..------------ .................. City ...... //....... ... Contractor's Name •-- ........license # ..._ Phone - installation will serve: Residence 20 Apartment House Commercial OTroller Court 0 Motel ❑Other ------- Number of living units:.... Number of bedrooms _ I......Garbage Grinder AQ..... Lot Slue .II �/�.0�1 DQ................. Water Supply: Public System and name -••--••••---•--••-•••--•-•............................................ ........................................Private ❑ Character of soil too depth of 3 feet: Sona b Silt:❑ Clay ❑ Peat❑ Sandy Loam o Clay loam ❑ IN. -.Hard an. __ Adobe Fill Material ..... .if yes,typo ........... ............ (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 [ SEPTIC TANK .3 Size.....................................•---------- Liquid Depth .........4T................ c ;r Capacity Type -----_------------ Material ..................... No.., Compartments ....... ' �•�`� '-,.,.� Distance. to nearest: Well ...---.Foundation ...............-• .. Prop. Lini � LEACHING LINE. [' j No. of Lines .....................__ Length of each line........................I— Total Length ..................... 3 � 'D' Box ............ Type .filter Material ....................Depth .Filter Material .........................--.................. Distance to nearest: Well ------------------------ Foundation ..._............._....-. Property Llne ........... SEEPAGE PIT ( ] Depth _____________ Diameter .___,_--,-...--. Number ............................ Rock Filled Yes ❑ No. Water Table Depth ..Rock Size ...:........... - Distance to nearest: Wel! __Foundation Prop: Line REPAIR/ADDITION(Prev. Sanitation Permit •...__ -------------------- ............... Date ___...............................I iSeptic Tank (Specify .Requirements) -----•-•--•---•---•----------------------------------------------------------------------------------------....,........--•-- ............... !�! Disposal Field (Specify Requirements) AI,SMV4_____�e�__P_r....1'7`l_"G.417 7 U.V,,C.....T:-x__._621?-0 ................. ---------------•• -------------- ------------•----•--•-------.,--_-------..._--•--•------._...-•--.......--------_.......---•---------- ...................... {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:Dlstrict. Home owner or Ilcen. 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 ---•.......(:.If....... . _. - zBY --------------------------- o Title �Owner ----- oher ownerl FOR DEPARTMENT USE ONLY E -.. ..._-_�_ ."1' ., APPLICATION ACCEPTED BY - - - - -- • -- ------------------------------•----------------•-•---......- -------- DAT - ----------....._::� .•, BUILDINGPERMIT ISSUED -- ----- ------------------ ------------------------------------- --------------------------•-----------DATE ----------__......_.. . -...-------- ADDITIONAL COMMENTS -------- ------ -----------------.---- -- ............. ---.._._..--------------------------------------------------•--..........------------------------------ ----------------------------••---.............................................................. -----------------------•-----.- --- '_......... .._....__.... f FinalInspection by: ----- - ----- .....-........................... ------......_.__........_.___ ................. Date ...... �. .- .. E;H 13 24 1-68 5M SAN JOAQUIN. .LOCAL ,HEALTH DISTRICT "'m 8/7h 3M