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'�a PP�t':ATI FOR OFFICE USE O N SOF. SAN1TA7ION PER o' �t... ----------------------------------- Com 1 Permjt No: .. � ( p ete in Triplicbte) ` -----_ This Permit Expires 9 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 ovnty Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ._Cf_ J�.-- -------- - •----• � � v ' r CENSUS TRACT ---------------_------- Owner's Name _Z- :6 ---- ------- ----_ - -------------- ------ ----Phone---------- --------------•-•-•----- Address Ajo.. 0---�----- City -` Contractor's Name ---------.License # o? Phone � Zi Installation will serve: ResidenceXApartment House C] Commercial oTrailer Court C] Motel ❑Other ---------------------------------_--------- Number ----------- ------------------------------- Number of living units.---/--- Number of bedrooms =__aP-.__.Garbage Grinder ------------- Lot Size - 49_________________ _____-.--- Water Supply: Public System and name ---•----•--------------------•--•----------------------------- -----------------•------------------- ---------Private ®' Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Gay ❑ Peat❑ Sandy loam ❑ Clay Loam ❑ Hardpon.W Adobe '❑ Fill Material ------ If yes,type ____-______________________ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) '-yj 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 Capacity --------------------- Type -------------------- Material---------------------- No. Compartments --------- -•---= Distance to nearest: Well ----------------------------- "; ' p ' 4 ------Foundation --------------- '.:... Pro Line ...::--=-- LEACHING LINE [ No. of Lines ------------------------ Length of each line---------------------------- Total Length ................ 'D' Box ------------ Type Filter Material --------------------Depth Filter Material .--•---------------.................... .:_-- Distance to rtearest: Well ------------------,....... Foundation ------------------------&P operty Line. ------------------------- --- SEEPAGE :SEEPAGE PIT Depth --------- ---------- Diameter ------ Numb'er -----------------------:_-- Rock Filled Yes '❑ No ❑' .. Water Table Depth -------Rock Size Distance to nearest: Well -''..............:......................Foundation--:--- ------ Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# -----------------------------•---------------.Date---'-'--: -----.---..::-.---____-I i - Septic Tank (Specify Requirements) ---------------------- -------- -- ----------------------- - - ------ --�-- - c-- -------- (� - ------ A,_Field (Specify Requirements) _ --------- ----------------------------------------------------------------------- - -- - -----•--- -- s---------------------------------------------------- ra ----------------------------------------------------------- raw.e rsting.and required addition on rev se side} �. 1 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 th4.'San Joaquin Local Health District. Home owner or lice sed agents signature certifies the following: "1 certify that in the performance f the work for which this permit is"issued, I shall not employ any person in such manner as to be ens. Wec t to prkm ' Compensatl[an aws of California.", ; �.. Signed --- ---- ----------- Owner i BY --------•---------- ----------------- ---- ------ litle ------------------------------ (If other than owner) FOR DEPARTMENT USE ONLY p APPLICATION ACCEPTED BY T ------- ------ ----------------- DATE ----//n '� 4k{ BUILDING PERMIT ISSUED ' -------- ----- --------------------------------- --------------DATE ------------------------------------------- ADDITIONALCOMMENTS -------------------------------------- ---------------=----------•---•----- ----------- ------------------------- ------- ---- ---------------- f -------------------------------------- -- =' -------------------------------------------•----- ----------------------------------------------------- ---------------------------------------------------------- ---------------------.. .--------------------- / f - ---- Fina! Inspection by: Date SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.