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FOR OFFICE USE: APPLICATION ICOR SANITATION PERMIT � � 9 •---•................._..-.................---•_.._..._. - Permit No. (Complete In Triplicated ... .. This Permit Expires I 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 A)DRE5S/LOCATION .! CENSUS TRACT .......................... Owner's Name .........p �` -7---.. .:...................................•............. .. ....Phone .. Address .............._._...P��` I- - -F• .... City .. ........................... Contractor's Name r . ----•........................ License # .. 3.... Phone � ��?................... Installation will serve: Residence❑Apartment Ho' mercial❑Trailer Court J-] _- T Motel ❑Other ' .... Number of living units:............ Number of bedrooms ............Garbage Grl der ..._ G-.1Lot Size ...-...-... _...........__...... Water Supply: Public System and name ...................................................... ..... ...._..._ . .t ................PPrivrivate ❑ Character of soil too depth of 3 feet: SandEl Silt❑ Clay ❑ Peat❑ Sandy Loam o Clay Loam ❑ Hardpan[ _, Adobe Fill Moterial ............ If yes,type............... ............ (Plot pian, 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 204 feet,) ff PACKAGE TREATMENT 1 I SEPTIC TANK Size...x ..................... Liquid Depth .. . 0.-... -- -- ----- Capacity - �.... T ------ Materlal..-�-1-�1.: No. Compartments ......... O Distance to nearest: Well ....................................Foundation ----1 Q........... Prop. Line --_.I.-S............. D LEACHING LINE No. of Lines .._.-l............. Length of poch line-...... -Q............. Total Length .....60............... a 'D' Box ......---... Type Filter Material .. .. ............. filter Material ........ ..................... Distance to nearest: Well ...............r"....... Foundation ........ Property tine ... orrr SEEPAGE PIT Depth ...,�.�..----. Diameter -- .--_-- Number --------1..�. -_....... R� k Fled Yes No Q Water Table Depth ..........--•----•..............................Rock Size Distance to nearest: Well ----------------------------------------Foundation .--_- a--�.... Prop. Line ................. REPAIR/ADDITION(Prev. Sanitation Permit# Date ................. SepticTank (Specify Requirements) -------•................................... .............................................................I................. . Disposal Field (Specify Requirements) ---------------------------------------•------ •-••---------------------••-•--------- •---................................................. ................ -•-•••-----•--•----------- (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 become subject to Work an's Compensation laws of California." Signed --- - --------- Owner Y -•-- $ - f -•------------------------------- -••---•----• Title - (If other tho wnerl FOR DEPARTMENT USE ONLY ' APPLICATION ACCEPTED BY .-- -- ---- ........................................... --•-----------...----•--• DATE '...7 -------------- BUILDING PERMIT ISSUED -- �^l ADDITIONAL COMMENTS ..f�- a d ��a_eP.�'`- __.�_r P2 /.5-... -?��.•. 1 � e....�I�.�. r- ............. ------------------------------ ---------------------------------—. ----- ................................ .... -------- -------------- :. .- ----------------- ----------------- ----------------------------..-.-.---------------------------------------- final Inspection by: .. -•- - --- • --- Date ..... � EH 3 2h 1-68 Hev.65MSAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M