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FOR OFFICE USE: :9 A' LIGATION FOR SANITAd10N111%R"M2rT 1Ar --------- � � � (Complete in Triplicate) Permit No: --------- ------ --------- This mit Expires 1 Year From Date Issued Date Issued/!- _7�� 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/LOC ION t't1 � L1-- = - --------------------------------------------' CENSUS TRACT Owner's N m ----- --- . --- Ph - one 7ta4-__j T Address _VP40L-- 1 7Z _- GG City - - Contractor's Name --_____._ e ,•�/J- _ ---- f ---- -- -•- -- - --- - ---�------- -- -- - - ----•---------.License # /�-a_Sl/----- Phone - - - i Installation will serve Residence ❑Apartment House❑ Commercial:]Trailer Court .C]' Motel ❑Other Number of living units:----- -___ Number of bedrooms ____yGarbage Grinder -------- Lot Size x1.3 -------- --=-------- Water Supply: Public System and name -------------- cs__..-_-_ ,,'}- . -----------------------------Private E]Character of soil to a depth of 3 feet: Sand'] Silt Q VC a+yei[D Peat❑ Sandy loam Q Clay Loam.0 r:Y� I Hardpan ❑ Adobe Fill=Material ----- ------ If If yles, type ---------------------------- Y (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 o'r:se 2ge pit permitted ,if public sewer is available within 200 feet,] i PACKAGE TREATMENT 6Li { ] SEPTIC TANK{ l Side= ---------------------------- --------- Liquid Depth ------ ---------------•-- Capacity ____________________ i Type -----------------_-- Material--____ No. Compartments ------ --------------- - . Distance to nearest: Well --_-..--_- -___ Foundation ._ 't' ------------- Prop. Line -------------------- -- LEACHING LINE No. of wLi�....,- C ] fines -.____ '______._- Length of each line__.- -____ ____ _ Total Length f ; 9 ----------- --------•------- D' Box __-_ Type Filter Material'--------------------Depth FilterMaterial -------------------------------------------- 1 Distance_'to nearest: Well __-------- _-- -Foundation Property Line -------- - SEEPAGE PIT L 1 Depth _ Diameter _ —— Number ________________ ______ _ Rock Filled Yes 0 No ��. Water Table Depth---- -------------- Rock _Size --Distance-to-Fnearest: Well ------------`-` "--------------------Foundation ------------------- Prop. Line -------------------- REPAIR/ADDITION(Prev. Sanitation Permit#----------_------------_ __________L- -_-- Date Septic Tank (Specify Requirements) - -_____-_ ------- ------- - ---------- Disposal Field (SpecifyRequirements] -_-----___- ----------------------- -� - - ------------------------------------------ ---------------------------------- ------1___'Y`' fa - --------------------- ----- - - 1 1 (Draw existing and required addition on reverse side} I herebycern that f have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, andliules 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 Workman's Compensation laws of California." Signed -----------------------ytn ------- Owner r BY ------ -- f Title ------------ �(If otheowner) �' ------------------------- �• Y FOR�DEPA�tTMENT VSE ONLY APPLICATION ACCEPTED BY t -- DATE -- BUILDING PERMIT ISSUED ------------ ------------------------------------------------------ -----DATE ADDITIONAL COMMENTS --------------._ -_____-_ ------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------ --------------------------- --- --------- ----- ---------------------------------Inspection b { ----------- --rtOA�QUIN p Y -Data ------ ------7>S LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M