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^ i OFFICE USE: gppI,ICATION FOR SANI,TATIO,N PERMIT r�r' _ �� 3v----- ---- Permit No. 1a-�-------3_. + �: -�� -'-- ,�; -----f-- """"- - --------- � {Complete in Triplicate) ----------------------------------------------- This Permit Expires p 1 Year From Date Issued Date Issued ____ _ Local Health District for a permit to construct and install the work herein Application is hereby made to the San Joaquin described. This application is made in complibnce with County Ordinance No. 549 and existing Rules and Regulations: a CENSUS TRACT -------------------------- JOB ADDRESS/LOCATION-1- L?9-- -- -- f+-f� t1! - _..._Phone ---------------------------------- Owner's Name .____Address ------- ----------------------------------------------------- - Cil ry Contractor's Name _------yf - ------ License #� ��- ,►�:� Phone Installation will serve: Residence $Apartment House ,Commercial:❑Trailer Court ;❑ �. . Motel ❑Other .------------------- - Number of living units-.---/- Number of bedrooms ___-__Garbage Grinder t?-- Lot Size -- F ----------------1 --- ------ -Private . Ise I Water Supply: Public System and name ---------- --------------------- •--------------------------------------------- I Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam 'D Hardpan ❑ Adobe$ Fill Material ----- ------ If yes, type ---------------------------- (Plot plan, showing size of loft, 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,) Size_ ____.__ Liquid Depth _ _ PACKAGE TREATMENT [ ] SEPTIC TANK' -��-�'-` �-- - - ----- " ��'-------•-------- V No. Compartments __-.fin ............. Capacity - po--- Type��leA6 Material_ E'2_�P�--�-- ' � r foundation------------- Prop. Line _v%.__-_-•-- Distance to nearest: Well __ --�•�-- ------- —It LEACHING LINE- ( No.of Lines;. ;.------------ Length of tach line- ' Total Leng h - --• -- -- --- - e th Filter Material ,C ------------------------• 'D' Box - �_� Type filter Material`s-�p P � � Founcidtion _ Property Line -- - --------------- Distan a to nearest: Well ---�o------------ ��-------- p � - Diameter Number _"'� ..----- -- --- ----- Rack Filled Yes No i[j `i SEEPAGE PIT' [ Depth - ------ - �------ Water Table Depth -------------- -----------Rock Size � ti Foundation _ C --------- Pro Line .! -----• Distance to nearest: Well ._= --fes-- '�� ----- r Date ----------------------------------1 REPAIR/ADDITION(Prev. Sanitation Permit r# -------- --------------- t Septic Tank (Specify Requirements _.._____._________..-_"---- -------------- IF. ----- ------------------- Disposal Field (Specify. Requirements) -------------------------------------------------- , , --------------------------------------;---------- -------------- - --------- -------------- ---------------- (Draw existing and required addition onbreverse 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,.) shall not employ any person in such manner i as to become subject to Workman's Compensation laws of California." Signed ----- ---- -------- - Owner . ,. "------- �_ -------------- Title . other than owner( o FOR DEPARTMENT USE ONLY -- ' APPLICATION ACCEPTED BY ----- ---- ------- - ---------- -------- - DATE -- --------------------------------------------- - �BUILDING PERMIT ISSUED ------ ---- --- - --------------------- DATE - - ------------- ADDITIONAL COMMENTS ----•------------ ------- ----------------- ----- --- ,ro.. _______.____________________________v ______-J.._- .------ - - ___ __________________________________"_____---------------------------------------( _______--_.____.__---_._-__ _--___ ___-_____.__ _ °tI'm��IQ__. -_ ---�--------- ---- ---- ----------------- . ----------------------- I --------------------------------------- ----- --------------------------------- ---- ----------------------- k � ------------------ ate --------- - -- ---- ------- -------- Final Inspection b SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'bB Rev. 5M w