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t 1`61t OFFICE USE:. J APPLICATION FOR SA ATION PERMIT P ' ermit No. ---71_-_ -- 1Complet Triplicate) -------------------- --------- --------- -------- - This Permit Expires 1 Year l=rom Date Issued Date Issued Application is h reby made t the San Joaquin Local Health District for a permit to construct and install the work herein . described. This 1pplliicatio�ri�s made' in compliance with County Ordinance No. 5 49 and existing Rules and Regulations: y CENSUS TRACT ---------------------- JOB ADDRESS/LOCATION -- - t L '}} off f /; 3 one �_7�� Owner's Name - c ------- --- '-- City, I Address ------ 1 t __ Ci --------------- Contractor's Name ________. _1-_ �� :License #� � Phone66-� - Q- •- -- - 1 ,`.-- mmercial : Trailer Court �] Installation will %erve: -v�es�dence�Apartment House❑ Ca n• Motel ❑ Other -------------------------------------------- Number of living units:___{______ Number of bedrooms ----- _.Garbage Grinder ______. Lot Size ----1�- ---- k Y � 6f [t.�h •4_ Private ❑ Water Supply: P�blit System and name -___--___r_ _��---- Character of soill.to a depth-of-3-feet: --Sand`h----Sift�� Clay-0 Reat❑ dy Loam�.F] Clay Loam El Hardpan ❑ Adobe Fill Material ______��hf yes, type ---------------- -------- ' buildings] .etc. must be placed on reverse side.) (Plot plan, showing size of lot, location of system in relation to wells, ` NEW INSTALLATION: (No septic.tank or seepage pit permitted if public sewer:is available within 200 feet,) C TAMC Size----------------- ------ ------------------ Liquid Depth --------------------•----- �1 SEPTI PACKAGE TREAT MENT [ ] I C I I I �� Capacity�-_---�•"a`__—."TYPe -- --------- No: Compartments ------_-•------------- C Distance'to nearest: Wel! _--___--____ ___.---Foundation _ _______ - _ Prop. Line -----------------•---- LEACHING [ ] No. of Li les _�---------------------- Length of each line-------------------- ------ Total Length ----------- ---------------- D' .13ox,._ __ Type Filter Material --------------------Depth Filter 'Material -----------------------------------•-- � �, i Property Line --------------- ------ I Distance o nearest: Well ------------- -- - -- Foundation -------------- ------ P .ty ° #-- _--__ Diameter ---------------- Ny,mber ------------------ ----_ Rock Filled Yes ❑ No'C i SEEPAGE PIT [ ] Depth ---- __----. Water Table Depth ---- -- -------Rock Size ----- ------------------"------- �— �`_`1 — Foundation =--------- Prop. Line -------_--------- I � Distance to nearest: Wel! _____________________________________ __ REPAIR/ADDITION(Piev. Sanitation Permit# ".------ --- Date ------------- ------- ---------- REPAIR/ADDITION I v . -- = -1--------------------•----------------- ---------- Septic Tank (Specify Requirements) __" `--- --------- ! a �-- cQ �� Disposal Field {Specify Requirements) _____ ! t 1=. 3 •--3�", r, ?•� 4T_!�---'� -- I A ------�-------------------------------------------------- -------------------------------- -------- - --------------------------------------------------------------------------- --------------------------------------------------- ? ) �• (Draw existing and required addition on reverse side) hereby certify that tl have prepared this application and that the work will be done i% accordance with San Joaquin 1 Y Y y ; I County Ordinances, State Laws, and #Rules and Regulations of the San Joaquin Local Health District. Home owner or icen- [ sed agents signature certifies the folloiiing: "I certify that in the performancef of the work for which this permit is issued, I shall not employ any person in such manner I as to become subject to Workman's Compensation laws of California." Signed --- ----- ------------ Owner - ------------- -------- rTitle ------ ------------------------------- ---- -- - ----- # (If other tha netr)�" '! o FOR DEPARTMENT{USE ONLY APPLICATION ACCEPTED BY ____ - - `� DATE .__.S`_-- -- �1.-----------="----" BUILDING PERMIT ISSUED = ----DATE -- ---------------•-------- ----- ADDITIONAL COMMENTS ----------'-------------- -------•-----•----------------------------------------------------------------- -----------------------=----------- °r -------------------------------- ;----- ---------------------------- ------------- -------------------------------------------------------------------------------------- ----------------------- ------- --- -- Date ---- - ---- - -------------------------------------------------------------------------------------------- Final Ins ection b --" j SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'b8 Rev. 5M