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' FOR OFFICE USE: ; 3 APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. .__/______________S`' ------------------ ------------------------- , � - 7i ------------------ 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- JOB ADDRESS/LOCATION .-___._ _-_- ---------Je:_____� � "-_----��NSUS TRACT __________________________ Owner's Name Phone �G-��- '�� Address ----------------- -a,f/lv - City Contractor's Name --- L , _._ .�.� /�, -License# af _ __ Phone '� 2p Installation will serve: Residence JVApartment House,❑ Commercial ❑Trailer Court ❑ Motel ❑Other -------------------------------------------- or --------------------------- - v Number of living units:____ Number of b roo/ms __. ____Garbo a Grinder _ Lot Size __7` .l�-_� 4--.-------- Water Supply: Public System and name ----- C-1: ❑ _.. _��__..�..�------------------------•---.._----------------------------------------__Private Clic cter of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ;❑ Hardpan ❑ Adobe�r 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.) `A NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) s PACKAGE TREATMENT [ ] SEPTIC TANKX Size--Icz--_ d.___ --- - Liquid Depth --- 1_______________ ___ CapacityfaZ&UType j Material..- No. Compartments ---- ........... Distance to nearest: Well ---f 4___ ---___Foundation _XQ__.__-__-_-_ Prop. Line -_--`_S.............. Length of each line__lG_ ___� g O • LEACHING LINE � No. of Lines ______ ___.__ Total Length ,t... .............._... 'D' Box,t/L2.__-_ Type Filter Material 44-------Depth Filter Material _Z_F...,______________________ _____ Distance to nearest: Well ._ .. --------- Foundation ---eV-- ___-____ Property Line _4. .'.............. SEEPAGE PIT Depth --- ----- Diameter Number -----!°------------------ Rock Filled Yes 'LA- No 0 Water Table Depth ----------- 4__'..........................Rock Size _A ------------------------- Distance to nearest: Well _A C/____________________________Foundation Ia_-_r--------- Prop. Line _... ........... REPAIR/ADDITION(Prev. Sanitation Permit# _.. -------------------- ----------------- _--- Dat ______-____--_--_----____-------__) Septic Tank (Specify Requirements) ------------------- --------�`'` `-— ---- �' it/� Disposal Field (Specify Requirements) ----------- - -- ------------""�----------�-'�✓---.�+:�-1y,_----------------- - ----------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------•------------------------ ------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------__ (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 ,Q BY ------------------- --- =-------------- Title --------- ._, --------------------------------------------------------- If other than owner) 1 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY__' _ --_. DATE��'-=__ _-_____- .________--__ ------------ --- -- --------- -- -- BUILDING PERMIT ISSUED ----- -------------------------'--= --- -- ----- --- ----DATE ADDITIONALCOMMENTS --------- ----------------------------- ----------------------------- --------------------------------------------- -----=--------------------------- - - -- - - ---_T_, ----� - -- - --- - - =�] -- L� '`s� Z - ----- --------------------------------------------------- N ----------------------------------- - - -------------I------- Final Inspection by _ r.. -- ----•--- -------- - --------------•---Date -- _ ----- ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M GA�