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FOR OFFICE USE: APPLICA7IQN FOR SAN S� ITAfiI�I PERMIT (Complete in Triplicate) Permit No. 7./Ir_____--- This Permit Expires 1 Year From Date Issued Date Issued `�-71__. 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. 544 and existing Rules and Regulations. _ JOB ADDRESS/LOCATIO - -•--------- ...... . ....--- -- �'`'`'L ' _CENSUS TRACT -------------------------- Owner's;Nam .Owner's;Name -- --- ,. Address - -----:---------------- ----------- City Contractor's Name __.- � � ----- -- -'---- License #off 'l7l_ Phone,/// IZ� '. Installation will serve: ResidenceApartment House❑ Commercial ❑Trailer Court j Motel ❑Other ---------------------- Number of living units------ Number of bedro t s __r�___.Garbage Grinder _ � Lot Size jr--- I./ j�: ---------- WaterY ------ ----�" Water Supply; Public System and name _,--___ Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt[] ClOY-07 Peat❑ Sandy Loam ❑ Clay Loam ❑ i Hardpan ❑ Adobe ' Fill Material ------------ If yes, type ---------------------------- r s (Plot plan, showing size .of lot, location of system in relation to wells, buildings, etc. must be placed-on reverse side.) (� 6 _ _ Y NEW INSTALLATION: ` (No septic tank or seepage pit permitted if public sewer is available within 200 feet,j ! PACKAGE TREATMENT 0 i '�� SEPTIC TANK' Size___.-- �[ ------ Liquid Depth -----_Ir_l___�_.---- i- Capacity (JG illfype _ _ _ __ Material___d -.,�•_XNo. Compartments ----_��____. __..-- Distance to nearest. Well ._ ._ ' �--�-R-Q�----Foun/d�a�tian _.,�C�- --------- Prop. Line --_-�- ------------ , LEACHING LINE No. of Lines ________�________ Length of each line/A7- I - ----------- Total Length ��-------- = # D' Box*#40'_'____ Type Filter MaterialDepth Filter Material __ 1 ---------• ------------ 11, bistance to nearest: WeIIY!__ � Foundation ________________ property Line _____ - SEEPAGE PIT Depth °S Diameter _- �*�____- Number'elp --_______ _____________ Rock Filled Yes ( No Water Table Depth ---------- Q-/ ----- ------Rock Size ----- --- ---- ------------ Distance to•nearest: Well ---__Foundation _- - ------ Prop. Line _____- r REPAIR/ADDITION(Prev. Sanitation Permit# .-______.____---- r • ------------- ----------- Date -------•-•------------------------} ry:�;h Septic Tank (Specify Requirements) ____..__._________________________ a.. -------------- Disposal Field (Specify' Requirements) -- ------------------------ I -------------------------------- (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 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 BY = Qc cc- -C ---- Title ' � . � [!f o#her than owner) V---"""""" ------------- j FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY . ...................... / ` BUILDING PERMIT ISSUED DATE ---'SjlT T{" "------------- ---------------------- ---------=---------- --DATE ---------------- -------------------------- - ADDITIONAL COMMENTS --------------------------------------------------------- ------------------------------- ------------------ ------------------------- ---------------------------------------------------- -- --- ----------------------------------------- ---- •---- - - ------ ----- --------------------------------�•—---- -- ------------------------------------- ------------- ina Inspection by: ___ __ ate --------- -- - --- - -- - - - - ---------------- �_ --- SAN JOAQUIN LOCAL HEALTH -DISTRICT E. H. 9 1-'6$ Rev. 5M E ��./