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FOR OFFICE USE: ---- -j PLICATION FOR SANITATION PER ----- -- (Complete in Triplicate) Permit No: __--_____------71 --------- ----- ------------------- --------- -------------- 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 described. This application is made in compliance with County Ordinance No. 549 and existinFevUcUrherein g ules and Regulations: JOB ADDRESS/LOCATION .- _ ---------------- -------- "-------CENSUS TRACT -------------------- Owner's Name ___ ` � o/� . �° - ---------------------------- ; Phone I Address - -a- -- i?..----X1___ --------- City: ` Contractor's Name .. - - ..� ` - -----------------------------------License,# e;,' _ - Installation will serve: Residence JkApartment House[] Commergial,❑Trailer Court Motel ❑Other f Number of living units:--- Number of bedrooms ��-___•_Garbo a Grinder _ Garbage /�e.-- Lot Size ,��/_7 --------------- --- ---- Water Supply. Public System and name -� pP Y Yp ='-- - ms'---e.a��jl��'------•-----•-- --------------------Private ❑ hh Character of soil to a depth of 3 feet: Sand'[:) Silt E] Clay El Peat E] Sandy Loam ❑ Clay Loam ❑ I, i Hardpan E] Adobe k° 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,) v PACKAGE TREATMENT [ ] SEPTIC TANK,. Size._ 7 - ................. ----- Liquid Depth ' Capacityl, V----- Typ;a Material s `-___ No. Compartments � ------- J Distance to nearest: Weil ____=777 _________ Foundation10--------------- Prop. Line_ LEACHING LINE �(f' No. of Lines ___.-�_______----- Length of each line-_ ' � -------------- Total Length /� 'D' Box �f _ Type Filter Material / - epth Filter Material Ip---------------------- -•-----•-_- F Distance to nearest: Well ---.,,wry >-.___--__ Foundation -_- - -----�-_._.._ _ Pro i .� Per a� ty _fine_-�--__._�---�---:�----- SEEPAGE PIT (/r Depth __v ---- Diameter •�- _____ Rock Filled Yes, j No i[] Number -- Water Table Depth A --- " " Rock Siz Distance to nearest: Well ---______-` ' , ,: Foundation _ ---------- Prop. Line -_�----- REPAIR/ADDITION(Prev. Sanitation Permit# -------_-----------_ ----------------- Date Septic Tank (Specify Requirements) ----__ _________ - 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 Workman's Compensation laws of California." Signed ----------------- ---- ---- -------- _ Owner ' - --- - � --------- ------------------------- I I By ----------------- --- '----'-- --_ Title ------ ---------------------- � � (I her than owner) ----------------------------- FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED B-- I- ��r Gtc-ti BUILDING PERMIT ISSUED ----- c�--------- --------------------------------------- DATE _�.� ------ ADDITIONAL COMMENTS �= t - ---------____-- --- - ---------- ----------------- DATE ------------------- ;----- - --------- "----------- - - ------...-- ---------- "---------- - ---------------------- ---------------------------------------------------------------------------------------------------------- ------------------------------------------ ---------------------------------- -------- -- - ---- -- ---------- --------------------------------------------------------- -- --- --------- -- --- -------------- Final Inspection b -------------- ------------- --- p -- ----- - ------ --- ------ -------.Dat 3 - - ------- - ------ --/--------•--...-- SAN JOAQ IN LOCAL HEALTH DISTRICT ) E. H. 9 1-'68 Rev. 5M