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FOR OFFICE USE: k f�-ICATION FOR SANITATION PERM.'' / Permit No. (� -3 (Complete in Triplicate) ff ---------------------------------------------------------- ________ 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 compp/liance with County Ordinance No. 549 and existing Rules and Regulations: J08 ADDRESS/LOC ON �--,- _ ---------- -------- f_7 -------- l ---CENSUS TRACT �,� ----- Owner's Name ??-�--- � ---Phone Address __.____ _ r G -,�1�= -! - --- - --------- -----------------•--. City __ _ �� K-- ---- Contractor's Name __ rtf/ ( .� License # y/ Phone llpl ----------- Installation will serve: Residence ❑Apartment House❑ Commercial❑Trailer Court Motel ❑Other Number of living units:__�r-_4'9._ Number of b drooms ------------Garbage Grinder ------------ Lot Size ��_ Water Supply; Public System and name ________ ___1 __ '�" Private ` Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam 0 Clay Loam ❑ Hardpan ❑ Adobe 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 seepage pit permitted if public sewer is available within 200 feet,) / PACKAGE TREATMENT SEPTIC TANK'[ ] Size--- --- .+ ___________ Liquid Depth - -l __-________. Capacityl� Vin - Type 1 �_________ Material C }L ------- No. Compartments ------ _.____.___. Distance to nearest: Well ?_?—_0t -------------Foundation/e- �_._ Prop. Line 16-__--------------- LEACHING ---- 3---_LEACHING LINE [ ] No. of Lines ________________________ Length of each line--------------------- Total Length .------------------------.__ 'D' Box ------------ Type Filter Material --------------------Depth Filter Material -------------------------------------------- Distance to nearest: Well _______________________ Foundation - ---------------------- Property Line ------------------------ r— � r SEEPAGE PIT Depth .R_J___1.______ Diameter �j�___ ___ Number -------&-------- __ Rock Filled Yes No Water Table Depth -----qa----------------------------------Rock Size -_a2--xg-- -----•----- Distance to nearest: Well _�<•-f/t'_—______=_r--____Foundation /A__AZ4A Prop. Line REPAIR/ADDITION(Prev. Sanitation Permit# --------.----------------------------------- Date -----------------.---------------_) � a ptic Tan (Specify Requirements) ______________________ f, Disposal Field (Specify Requirements) ------------- i '..- - -a --- -, , ---------- - --------------------------------------------------------------------------------------- --------------------------------- ------------------------------------------------------------------ -------------------------- ---- ----- ------ - --------------------------------------------------------------------------------------------------------------- ------- (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 becgytre sy. ject to W�rkma Is Compensates aws of California." Signed ---------------- =---- r �_------ --- Owner i By - ------- . - -_ --- �f - -- --- - = ---• Title ------------ ----------------------------------------- (If other than owner) 6 � , FOR DEPARTMENT USE ONLY �I` �/ Y ' APPLICATION ACCEPTED B '- ---------- - ------------------ -------------------------------------------- -------------- DATE Z � BUILDING PERMIT ISSUED - -------------------- ------------------------------------------------------ DA !7 AL MENTS r 1 --- __ --- ---- T ------------------------------------ -- - --------- - - ------- - ------ ------ - - - --- ---------------- ?------ -- i Inspection by: ---- --------------------------- ----------------------------Date J AQUIN LOCAL HEALTH DISTRICT � � � � L E. H. 9 1-'68 Rev. 5M