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FOR OFFICE USE: U 7 -�,,,_ f APPLICATIOR• 6eSANITATION PERMIT 4 rri (Complete in Triplicate) Permit No. - d. _________ 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 is described 'This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: ,:f L'' / r JOB ADDRESS%LOCATI - ------ --------- TRACT _____________________•_-•_ _ � f Owner's Name" - ---4----- - -- - - -- --= ----------------------------- ------- ----------Phone ,Z ��j w Address �`] (E' Pl ------{ `. City Contractor's Name --- --------- - --k_ --. ------- -- License #/ _. ---------- Phone -7_-�_�_� � -- --- --- Installation will serve: ' Residence Apartment House�❑ Commercial :❑Trailer Court ;❑ i Motel ❑ Other Number;of living`units:---.----- Number of bedrooms --__�___Garba rin er --- Lot Size ___X!__ Q..._._ Water Supply:.'Public Systemandname -------------- r _Private[7 _ _ _ Character ofrsoiI to.a_depth 6f 3 feet. Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay loam :❑ 4 I •* _Hardpan ❑ _ Adobe ❑.� Fill Material ------------- If yes, type ---------------------------- (Plot-plan; sh�_0tiing size of lot, location of system in relation-to wells.-buildings, etc, must be placed on reverse side.} NEW INSTALLATION:' 6(No septic tank or seepage pit permitted if public sewer is available within 200 feet,( - 4 / < ," 6 ' PACKAGE'TREATMI NT { ]; SEPTIC TANK V i ren/ S' e___J�---x ..----- ----------------- Liquid Depth --,� ------------- ire S. `� 1 k --- --capacity .2�______ T Jd"--_.-____--f--.-'-__ Material_ No. Compartments -- •4J Distance to nearest: Well -------------'----------------------Foundation 1�Q---it--------- Prop. Line _r�_��"____- LEACHING LINE No, of lines .-----�.-_______--- Length of each line_----- Total Length ,_�_ -------------------- 'D': _.0___ _-_•__ j 'D': Box .-------Type Filter Material. .__4�►JKS.,----Depth Filter Material ..../_&-------________________________ -..�=. I Distance fo nearest: WeJI-�----�'_________r_ Foundation -1 -:"`----_------- Property Line ------------ SEEPASEEPAGE GE PIT Depth ___- '':_-- Diameter e --------- Number ---------r�---/------"---- Rock Filled Yes No le Water Table Depth Rock Size l! _-' ').Y-�. i Dist nce to nearest: Well ________________________!----------------Found ation/Q_rf"----____- Prop. Line REPAIR/ADDITION(Prev'Sanitation Permit,#%------ ----------------------- ----------- Date`-------•----------I____-_--_-----1 Septic Tank (Specify Requirements) -------------- ----- - t 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 liven. sed-agents signature certifiesihe following: _ i._a.;. ..J._1 , J "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 of California." Signed ----------- ---------- ------ + Owner U BY Title (If other t i owner) ---- ---------------- -- L FOR DEtMTMENJ USE ONLY APPLICATION ACCEPTED BY - --------- 7 o M -------------------------------- DATE ----- 5:!r �a ,BUILDING ----------------------------------------- -----------------------DATE - .-- -AQDiTEONAL I 1F COMMENTS ----------------------------------------------------------------------------- -------------- -------- ----------------------------------- -------------------------------------------- - --------------------------------------------------------------------- ----------------------------------------------------------' a ------------__---------------------_-------_ ____ _____----------- __ ________._____---_____________.__----____--_____-__-______-_-______---_-______-__--_________---_--.________--_-_ --__________ - ____________________________________ __. _ _____________---______-____-___-_____._-__------______-_-________._-_-_-__ _________-___ Final Inspection by: _ -Date ------------------------ SAN ------------SAN JOAQUIN LOCAL HEALTH DISTRICT . E. H. 9 1-'68 Rev. 5M