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FOR,OFFICE USE: A. .KATION FOR SANITATION FERMI►Y; , ..:.- --------------- Permit No. } (Complete in Triplicate) 1-0 --------------------- { 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 Ordinance No. 549 and existing Rules and Regulations: DQrQs�� ----------•eeAee�-------------- -------- ------CENSUS TRACT ----- ---------- . JOB ADDRESS/LOCATION ------�--�--------- :------- - - •• ------- Owner's Name --------Fq` . .�3 J " Phone ----------------- -------- 1 � ? ---- --- ----------- Address �7�7 ��` ------------- - City ---- `rC ------------------------------------------- ------- Contractor's Name ------- �W"neA ------------------------------------------------License # -- ----------- --------- Phone --------/I will serve. Residence Apartment House,❑ Commercial :❑Trailer Court l❑ Motel ❑Other -------------------------------------------- Nv Ito X Number of living units:.-----L:--- Number of bedrooms __l-_--___.Garbage Grinder _.__- Lot Size _______________-__-----.--__--____-----.__ Water Supply: Public System and name ------4045``x---------------------------- ------------------ = -----------------------------------Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam .0 Clay Loam' 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,) �t PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] Size IL xS61c,•,TJ'�- Size------------------------------------------------ Liquid Depth ----- --------------------- Capacity ------------------- 7YPe -------------------- Material---------- --- No. Compartments ---------------------- Distance to nearest: Well ------------------------------------Foundation --------------------- \Q Prop. Line -_----------.-..------ LEACHING LINE [ ] No. of Lines ------------------------ Length of each line---------------------------- Total Length ----_--____.____.___._.._.__ 'D' Box ------------ Type Filter Material --------------------Depth Filter Material -------------------------—1-------------- Distance to nearest: Well ------------------------ Foundation ------------------------ Property Line ---_.--.__---_------.._- SEEPAGE PIT [ ] Depth ___________________ Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No 0 �XT50 P 0M." Water Table Depth ---------------------------------------=--------Rock Size -------------------------------- '000 Z__., ------------------.------------'Dooms, Distance to nearest: Well ----------------------------------------Foundation..------------------- Prop. Line ----------------- -•- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------) Septic Tank (Specify Requirements) ------------------ � --------------------------------- ------------------------------------------ __Disposal Field (Specify Require encs) ------------ . Iyo __--d ---__ E ----- A , ._.. r-------------------------------------- a = 1-_�-------------------- --------------------------------------------------- ------------- --------------- ------------------------------------------------------------- ----------------- -- ---------- (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 District. Home owner or licen- sed agents signature certifies tate 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 sub' orkman' mpensati.on laws of California." Signed ---------------------------------------- Owner ------==-------- Title --------------------------------- - ------------------------------------ (If other than owner) l I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY f= = -G !�/�f ua e=�---� ----- DATE BUILDING PERMIT ISSUED . -_ -_-_ __. ----- E' -- -DAT ADDITI AL CO MENTS . f - ,.----- f<�---- ------: �=p t��------ -- - -- - ----- ----- ------------ -- ` r _ , -,:- ________________ ----------------- - __ - -- -_ -- ---_.------------- ---------- ---------------------- _-___ ______________________________-----_-_7 ------.---_--:----_-_--_-----_-_------ ------------------------------------------------ _ - -_ - -------------------------- ---_----_-_--_--__--_- Final Inspection by: ` rDate .. SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. SM