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" .FOR OFFICE USE: _ _ APPLICATION FOR SANITAT16N PERMIT 1__.. _ ._ _ .. . . PermitNo. . 20=9 .. (Complete in Triplicate) .................... -- --- ---- ---- Date Issued �� Q This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local kealth 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: 11 _ - ,�/v __ CA I _ . ----------------------- rye r JOB ADDRESS/LOCA ION/�.t�.,�J-J..�-....LL=�.-- .- ��-------- ��--- ---- -'' - CENSUS TRACT ... Owner's Name ................. ......--- ---. Ph. .one . Address City --- -. - --- .............------ # Phone �'.. Contractor's Name --- Installation will serve: ! Residence❑Apartment House-0 Commercial:❑Trailer Court ❑ Motel E3 Other - Number of living units:---I------- Number of bedrooms -.Garbo e-Grinder ..'_.:.._-- Lot Size :--,_--._---- --------------- ----- Water Supply: Public System.and name -.--. - .... Private [�^ r - - g � Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam Clay Loam❑ y Hardpan E] Adobe C] Fill Material If yes,type - _...-._.- (Plot plan, showing size of loT0location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: INo septic tank or seepage pit permitted if public sewer is available within 200 feet,) �� - Li p PACKAGE TREATMENT [,] [ / SEPTIC TANK Size.. . �... -9--. .- --•-------- -- Quid Depth .-.- ..----- Capacitt�.��B --- -- Type Material .....__ No. Compartments -_. .-.--•:--__ _. i Distance to nearest: Well .-.._....5�Q...................Foundation -.../..p.--._...---- Prop. Line ...---..�-:--.-,-_-.-- r Length of each line...... ............... Total Length LEACHING LINE 4,-'N;. of'lines '.'_ __.-- ---' - • r rr r' 'D' Box�.�...... Type Filter Material ....2--�-.......Depth Filter Material ...../1. •---------•--- -- Distance to nearest: Well ____--..5.0..l...--.-- Foundation ....../..0._......---- Property Line ---------------•--•:••-- SEEPAGE PIT [ 1 Depth J------------------- Diameter ................ Number .......................-.--_ Rock Filled Yes ❑ Nob 1 rr TlIable Depth -_------- ...... ............ Rock Size --------.--------------------- Distance. -------- --- Ditanceto nearest: Well ............. ....................c....Foundation ---- -------------- Pro-p- . Line ..................... it --- Date -------------------- REPAIR/ADDITION Pe . anitaon Permit# - ---•-----••---------------------- - - - - G -----•-- $ep P (Prev. Requirements) ----:.. ..... ..... ......... ........................................ Disposal Field i5pecify Requirements) .--- -----............................---------------------...... -------- ----- --- ----- --------------------•-'--•---- 1 I _ " �( " - -�-------- ------------------- (Draw existing and required addition on reverse si e . � -�•••.� I hereby certify that 1 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: arson in such manner "I certify that in the performance of the work for which this permit is Issued, I. shall not employ any p as to become subject to Workman's Compensation laws of California-" ISigned ..... - --'--------------••--- ! --------- Owner .._.................. - (if other than owried 1l FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY i,- - --- --- -_..... DATE --..- BUILDING PERMIT ISSUED _..._i1...............•. ••---------- --DATE ----_------ -----------------•-------- 1:• ADDITIONAL COMMENTS :.j.................. ..... - ---------------------..........._........._....._..------....I - '----.... ..-------. ---- ............... ......... ............................................ ... —....................... . .--- - .. -------------- --------- --- -. -V/- ...........................---- -------- ,_. � f Date �-�-- _....... .... Final Inspection by: --------- _ z ..... • SAN J AQUIN LOCAL HEALTH DISTRICT ..^� • � 1 `E.H. 9 1-'68 Rev. 5M r