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FO OFFICE USE: 7/ :3 , 1-w APPLICATION -F It" ANITATI4N PERMIT ----------------------- Permit No. r - (Complete in Triplicate) - -------------------_-------_ rl L,-n---------- ---_ 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/LOCATIO ----- - , - r'PQn4" CENSUS TRACT Owner's Name ----------- ----- ------ ------ - - -`----- - --- --------------------------=- ---------------- City ------�---- Phone i Address ---- ----------------72 WU r Ci tY Contractor's Name ----------- �r - -- - , ---- --V,------------------------- License # ` �'� Phone ` / Installation will serve: Residence ❑ Apartment House❑ Commercial Wraller Court l❑ Motel ❑ Other -------------------------------------------- Number of living units_____________ Number of bedrooms ____________Garbage Grinder ------------ Lot Size -___--__---_-___-________________.________ Water Supply: Public Sys`tem'arrd-n-ame---_----- _-_. -- —•_,.------------------------------- ------Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam-❑ Clay Loam .❑ Hardpan ❑ ' Adobe 1% Fill Material ------------ If yes, type -------------_-------------- (Plot __ ---___(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 seepages pit permitted if public.sewer is available within 200 feet) fI ----------------- , . ,. Li------- quid Depth --- -- PACKAGE TREATMENT: [ SEPTIC TANK :. ize i q p I Capacity t � ._ Type __---_ _¢-'_______ Material- 7,hG - No: Compartments ___ ___ Distance to nearest: Well --_---_-_-__ -_Foundation Prop. Line ---------------------- LEACHING - -__'--'_------LEACHING LINE No. of Lines ---------1______________ Length of each ooline---------_7%D____.___-__ Total' Length ------7----..___'_.-_ i �{ITi r r 'D' Box _.________ Type Filter Material ____ _ __ ______Depth Filter --------------------- 10 r Distance to nearest: Well Foundation ---fi---�- Property Line __ ............:.... SEEPAGE PIT Depth .....00".-V Diameter 56-`____ Number _..___._.�________________ Rock Filled Yes No 'CNate`r Table Depth' -_ -_1 ----------------------------------------- Size--------------------------------- Distance to nearest: Well ________________________________________Foundation -------------------- Prop. Line ...................... R �V REPAIR/ADDITION(Prev, Sanitation Permit# ____________________________________________ Date _.___ __.-__--__.-..__. __________) Septic Tank (Specify Requirements) -----.----------------------------------------------t = i F Disposal Field (Specify Requirements) -----------.--------------- ' \ t (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, 1 shall not employ any person in such manner as to become subject to Workman's Compensation..laws 4of California." Signed --------------Jother ------- =-------- - Owner ------------------------- 1 By ------------- r-------- `----- = J '_ : Title ------- =---- --------- ------------------------------------ (If owner) t MENT USE ONLY APPLICATION ACCEPTED BY ----- - -- ---- -- -- - - ----- - ------------------------------- ------------------ DATE --- ------ .----------- BUILDING PERMIT ISSUED ------ --------- E -- ----- - -- --------------------- A DITIONAL CO MENTS - 7 - ----i -- -- - --- --- --- --- ------- - - - -l- ---- "---�"'---- '- _ � - -=- -fir Fi al Inspection by: ---- ---- ----------------------------------------------------- ------- -------Dae = ---- --------------- JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. M