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FOR OFFICE USE: APPLtCATIOW. OR ,SANITATION PERMIT -----------------------------------= __________p Permit No. _ ----- --------------------------------------- a (Complete in Triplicate) --------=- - 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 ith Count Ordinance No. 549 and existing Rules and Regulations:. JOB ADDRESS/LOCATION . ---------- - ----- -.CENSUS TRACT Owner's Name --- �J �:•------ -- ---------------------- �R t Phone Address <- --- - -- - City Contractor's Name -_- -e-fj� License # __--_ Phone ______________------------- - i� -•- I_--�rP3-n--------- --- - ----- - --------------- Installation will serve: Residence ❑Apartment House❑ Commercial Alrailer Court ;❑ Motel ❑Other ----------------------------- Number of living units------------- Number of bedrooms ______-__Garbage Grinder ------------ Lot Size 2._........ Water Supply: Public System and name ---------------------------------------------------------------------------------------------------------------Private' Character of soil to a depth of 3 feet: Sand❑ Silt❑ Gay ❑ Peat❑ Sandy Loam ❑ Clay Loam Hardpan ❑ Adobe Fill Material ------------ If yes,type _____________________--_ (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,) I f PACKAGE TREATMENT [ ] SEPTIC TANK)6 SSiize_------ __--__.__ _-- _---__- .---- -- Liquid Depth ______ Capacity _®_�------- Type _�"-'7 01 M terial_ _Isi_I___,_ No. Compartments ----._.. ........ Distance to nearest: Well --- � Found tion _____ __ Pro Line ____.___. LEACHING LINE No. of Lines ___ -- -- ______ Length each/ (ir1�r° /_ � Total Length ________,� __Q..... 'D' Box ____Type Filter Material-AV!l S_Depth Filter Material ----- .................... Distance to nearest: Well ------------------------ Foundation ------------------------ Property Line _...................... r SEEPAGE PIT Depth -„21—-------- Diameter __�!_ __ Number ---------- - --- Rock Filled Yes/;KNo 0Water Table Depth ------------ -d__ --- - --------------Rock Size _---- _1�ll��s - -- --- r Distance to nearest: Well ----------- ---------------------FoundationAh__-_�-____ Prop. Line ......; ........... REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------) SepticTank (Specify Requirements) ------------------------------------------------------------------------------------------------------------------------------------------- Disposal Field (Specify Requirements) ----------•---------------------------------------------------------------------------------------------------------- --------------- ---------------------------------- ------------------------- - ------ - ----- ------------------------------------------------------------------------ - - - - - - - - - - - - (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 ----------------------------------------------------- --------- --------------------------------------- Title -------------------------------------------- ------------------------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -------- - -------------- DATE -------- ---------------------------------- BUILDING PERMIT ISSU _ - __ __- - DATE ------------------------------,�-__ .-_� - - -- ADI�ITIONAL COME /�l9 to rP C--4----- -------- -------- --- -- oc c� �:r-: -- - ° -r --- --------------------------------------------------------- ------------------- - . Final Inspection by: ----------- CN --------- r® Date N JOAQUIN O AL HEALTH DISTRICT 1-'68 Rev. 5M