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FOR OFFICE USE: � a , d APPLICATION FOR SAW ATION PERMIT '73 "-Ikb -----f- '3----------- 41 Permit No- -------------------- = -- (Complete in''Triplicate) --------- ---------- --------------------- Date Issued -7� --- ------------------------------------ This Permit Expires ] Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is made in compliance with County Ordinance No. 54/,/Zea;:_�LACENSUS. existing Rules and Regulations. JOB ADDRESS/L N ._ _ 3� CF �f /7!_. TRACT -------------------------- Owner's NameLAL� ' Phone g � Cit f Addresses $CGI�f� r-- -- Y p/ Contractor's Name -- ----- G �C fs"r�___; �lC --License # o �` /__7— __ Phone �J Installation will serve: Residence ❑Apartment House,❑ Commercial ❑Trailer Court X Motel ❑Other ------------------ ------------------- ---- Number of living units-. Number of bedrooms ------------Garbage Grinder ------------ Lot Size f------ Water Supply: Public System and name -------------------------------------------------- --------------------- --------------------------------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam (] Hardpan ❑ Adobe 9 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.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) Ly PACKAGE TREATMENT f ] SEPTIC TANK j ] Size---------------------------------------------- - Liquid Depth -------------------------- X Sr''J7 Capacity -------------------- Type -------------------- Material---------------------- No. Compartments ---------•----------- 0 Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line ---.---------....----- LEACHING LINE [ ] No. of Lines ------------------------ Length of each line---------------------------- Total Length ------------_------------- fS��, D' Box ------------ Type Filter Material --------------------Depth Filter Material ------------------------•--.---------.------ 9 Distance to nearest: Well ______-____;._____ Foundation --_-_______-_______--- Property Line ________________________ SEEPAGE PIT [ � Depth ___r� __-__ Diameter _ --- Number __-______ ____ _ Rock Filled Yes No �S�/meq Water Table Depth ---- 45---------------------------Rock Size �-� �- I�---- f Distance to nearest: Well ------/-,SZ>----------------------Foundation _ZV____�___ Prop. Line .---.._-_.___-. REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------I Septic Tank (Specify Requirements) ----------------------------------------------------------- ------- ---- ---------- ------- -------- Disposal Field LS ecify Require ents) _ -- - --------- ;- ^ (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 beco ct to W rkman's Comp ation laws of California." Signed -- -- ----- -- ----- �"`�F ----- - Owner BY ----- --- -- --- ------- ------------- Title --- - (If other n o r] R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---- ---------------------------- ---- -- -------------- DATE .... et y 7------------------- BUILDING PERMIT ISSUED -------------------------- ------------- ----------------------------------------------- - ---DATE ------------------------------------------- ADDITIONALCOMMENTS ---------------------------- ------------------------------------------------------------------- ---------- ----------------------------------------------------------------------------------------------------------- - ------- --- ------------------------------------------ -----1-------------�-------- ------- ----------------------------- - --------- - ----- ------------- ------------------------------------------------------------------------------ - - -------------------------------------------------------------- ------ - ----- - ------- Q----- a -- ------ FinalInspection by ------------- ------ - - - -- ----- ------------------------------------------------------ -----.Date ----- SAN JOU E. H. 9 1-'68 Rev. 5M