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FOR OFFICE USE: .,r)PLICATION FOR SANITATION PERI.q,, Permit No. I..-. .... ------- - (Complete in Triplicate Date Issued 9- 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 County Ordinance No. 549 and existing Rules and Regulations: '� . -- ------CENSUS TRACT -------------------------- JOB ADDRESS/LOCATION -------- --�- 1..._. R- � c Phone . Owner's Name J -�:!..L�..C`. f- =� - ---- - ---- AddressCity ---•-•-------- •-------•---- -- �' - - License # Contractor's Name . -Z)�f.L f fir`L j-- Installation will serve: Residence EK�<Partment House ❑ Commercial ❑Trailer Court ;❑ Motel ❑ Other ---- -------------------------- ---- Garba e Grinder ....___-.-_ of Size . --- Number of living units:--_�_---- Number of bedrooms • --- 9/_ ��: °�^�—l A`° Private ❑ ' Water Supply: Public System and name _._____ ---------"IClay of soil to a depth of 3 feet: Sand 'F7 Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe ill 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.) d NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) Size..`7.b '�' ----�------------ Liquid Depth ----��:............... PACKAGE TREATMENT [ ] SEPTIC TANK [ ] . •-----•. Ca acit _/-2, �____._. Type 7�f�C '--- Material---------------------- No. Compartments ..�1------------ P Y ` ------------------------•--------Foundation .....c/ Prop. Line Distance to nearest: Well �- - I __- Total Length -- -76.............. LEACHING LINE [ I No. of Lines �5.-- .-- ..-- -- Length of each line__._1.01_-------.-- ..-Depth Filter Material ._-----------------•------------••-------•- 'D' Box ---�...._--- Type Filter Material .._............. __--- Foundation Property Line .-------------- to nearest: Well ..__._-.__. ----- - - - Diameter Numbe ------ Rock Filled Yes ❑ No 0 SEEPAGE PIT [ 1 Depth --- Water Table Depth ....--------------------------------------------Rock Size ------------ ------------------ ---------------------- Distance -------- ---------- Prop. Line - Distance to nearest: Well ......................... \ 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 Joaquir. 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 manne- as to become subject to Workman's Compensation laws of California." Owner Signed • . - _ Title . ---------------------- ------------- By -----•----- - (If other than owner) FOR DEPARTMENT USE ONLY DATE .... ................. APPLICATION ACCEPTED BY ,- "`------ -- . --................................•--•--• ....... -.DATE ......... BUILDING PERMIT ISSUED -- —�-- ADDITIONAL COMMENTS . - -- -- -------------------------------------------------------- ... ---------•--•--•- .......................................... C, 7 r --- ------------------------- ,-.... - - -- - - ,. _ ... .-Date / .......t..-t............... �"� - "-----•--- Final Inspection b v.�. "--'-"'--•-'---"- SAN JOAQUIN LOCAL HEALTH DISTRICT P H 0 1-'68 Rev. 5M