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FOR OFFICE USE: - �I t S APPLICATION PbIt�'SANITATION PERMIT ---------1 5 = -------/-- - Permit No .71 (Complete in Triplicate) ---------- ------ -- ---------------------- = ----- a:. Date Issued �,. T 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 compl' nce with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .. a_ 5____----- - CENSUS TRACT _-___.___.___.____.--___ ----- --- --- - - -- --------- - ---------- --------------------- Owner's Name --------------- ---- - l-- --------- ------- --------------- - -------Phone ------ Address ------------------ ---�-�------- ------ ----- -- ----- ------- ------ --------:- ----. City - -- -------------------------------------........ i - Contractor's Name ------ ----- ----4? --_--------License # .�-��f---- Phone 7� [?_:_ _ J.._ g f - Installation will serve: Residence�Apartment House❑ Commercial ❑Trailer Court i❑ _.. _ / . ..,. .Motel ❑Other-y ---------------------------------------- ---- �-- Number of living units:_______ Number of bedrooms --!Z:�7�arbage Grin _-.__ Lot Size 7Q ------------------ 1- -------------- Private Water Supply: Public System and Warne" - -4----------`°`--------"".-------T....'------- -=---- -- ---=------- -----------•------------ - ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam -❑ Clay Loam 7] I Hardpan [] Adobe ❑ Fill Material ------------ If yes, type ---------------------------- (Plot --___.________.______ --.(Plot plan, showing size of lot, location o€' system in relation to wells, buildings, etc. must be placed on reverse side.) 'V I O NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) 4 f SEPTIC TANK S, e____ . .________ Liquid Depth _-� ._________..__PACKAGE TREATMENT ------------- Capacity ________Ca acit Type Materiai_-c-e -1 No. Compartments ------- Distance •--Distance to nearest: Well ________________-________._.-------Foundation ---/0------------- Prop. Line ---� _-_--__ _ j LEACHING LINE No. of Lines `" F 'Length of- a line ___--____ Total Length :� ................ 'D' Box ------------ Type Filter Material. --- --------------Depth Filter Material ----- - -------------------------------- �/Distance to nearest: Well _.________''°�______� Foundation _---`�.�_"�------ Property Line. ___�.................. � SEEPAGE PIT ` Depth _-_2_ ____ ___ Diameter __ f".____3 Number ______.__�._________�`_;_- Rock Filled Yes Na i❑ N !r Water Table Depth i --'=-----------------------------Rock Size Distance to nearest: Well ____-_`-- �.:;------�---=-----------Foundation ----- Prop. Line . ---------.-_____-- I J REPAIR/ADDITION(Prev. Sanitation,Permit# ----------------------------------'--------Date --------------------------.-------) Septic Tank (Specify Requirements)--------------------- Field (Specify Requirements) ------------- ---------- -----------------------------------------------------------------------------•--- ------------------------------ -------------------------------------------------------------------------------------------------------- ------------ - --------------------------------- -------------------------- --------------------------:------------------------—----------- --------------�-----------------------------.--------------------------------------------------------------- (Draw existingand required addition on reverse side) I 1 hereby certify that I have prepared this applicatiori-and that the work-will-be done in accordance with San Joaquin f 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: "1 certify that in the performance of the work for which this permit is issued,,l'shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed --- -=--------- ----------------------------------------- Owner BY -----------'------ •------------- Title =--------------------------------------------- --------------------------- (If oth than owner) DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - - - ------- -- - - - --------------------- ---------------------------------I DATE _�':/If----�� ----------- BUILDING PERMIT ISSUED DATE ADDITIONAL COMMENTS -- ---- - - f� d --------------------------------------- ----� --:._yY---- --------------------- ----_----- --- --- ----------------- --------------------------- ---------------------------- --------•- ' Final Inspection by: a - at = Y �. = - - - ----- - -- Date SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'6B Rev. 5M r