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} FOR OFl`IChE i Icy :. f....�.... � _.: .__.. APPI E�,�►TiON FOR SANITh' JON P,...i4AIT -- Permit No. . .. ..:_L .. {Complete in Triplicafe) 1 -----.....................................-.............. Date Issued .....................................................I This Permit Expires 1 Year From 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 Count Ordinance No. 549 and a isting Rules and Regulations: JOB ADDRESS/LOCATION ._C l.. 4��_...4 _!•.......... ................CENSUS TRACT .............- Owner's Name _.. _.....-----••--•-----------------••--_•- .. .... ....Phone ----- AddressAr _ !_3 Cit ii------------------------- i . .............:. ----- Y --- --- Contractor's Name .............. . -- , .' - ._------ -• - ----.. ..- •....----------License.# u��.�/�„� Phone .....��..le�. .............. - . Installation will serve: ResidenceXApartment Housef[] Commercial F]Trailer Court t] i Motel ]Other ----•--------------•------------------.----- Number of living units:--- .-_- Number of bedrooms ..sP-_._.•Garbage Grinder ............ Lot Size ..Raa� ....... Water Supply: Public System and name ..-- ------•------•---•....--•--. ..........__....-•-_-.-•........................................Private' Character of soil to a depth of 3 feet: Sand'p Silt❑ Clay ❑' Peat[] Sandy Loam 0 Clay Loam [] I F Hardpan Adobe.C] 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.) NEW INSTALLATION: (No septic tank or Tseepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK( Size................................................ Liquid .Depth ........................... . r. Capacity .................... Type .................... Material...................... No. Compartments ................. Distance to nearest. Well ....................................Foundation .................... Prop. Line ...................... i LEACHING LINT= [ ] No, of .Lines ........................ Length of each line--------.__-__-._-___.__.--_ Total Length ....................... 'D' Box ----------.. Type Filter Material ....................Depth Filter Material ............................................ Distance to nearest: Well ........::...... ------ Foundation ------------------------ &P 6perty Line. -•-•---•-- ............. . SEEPAGE PIT [ ) Depth ---------l Diameter Number ---------------------------- Rack Filled Yes 0 No [} Water Table Depth .----.-_.__•.............:....... ..............Rock Size .-•---------- --- . Distance to nearest: Well _ Foundation:..:........ ......... Prop. Line __---------:------__ l REPAIR/ADDITION(Prev. Sanitation Permit# ............................................. Date.................................... Septic tosal Feld (Specify Requirements G. ....... :.. ._y. ... .. ..........'.-- [ Draw.a sting and required,;addition on rev se 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 licence sed agents signature certifies the following: � "1 certify that in the performance f the work for which this, poirnit isAssued, 1 shall not employ any person In such manner as t.6 he ens bject torkm Compensatn aws of California."' 1 Signed .. _ .�..•. Owner By ...................................... ----- --- -- Title ---•----_---_- ............... (If other than owner) FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ............... .. 1/� '6,� --- - --------------------- DATE -•-- -- - ----y------ -- ---....... BUILDING PERMIT ISSUED -------------------------------------- • --- -------DATE ........................................... ADDITIONAL COMMENTS ---------------------- --- ------------------------ ••------•------- --------------------------------------------------------------•- • -------•-••--•------.-........_. .---- ..........----.-..-...---......_...-.-._....... ------------ ----•-•• -• ...--•-------•----- ---------- .......... ............................................................ ............. Final Inspection by. .- - - .__._. ..............................................................Date ----- ---�--- --- ----r'�-------.:..•-.-- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M