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FOR OFFICE USE: -,,PPLICATION FOR SANITATION PERI Permit No. (Complete in Triplicate Date Issued .. 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: T CENSUS TRACT .....................-_... JOB ADDRESS/LOCATION � � �D�`—_.5.�.'_� .,.. . "-' p' =»-------------"--------•- 5-- --------------- Phone ....i __1�•'. _._.....-•-- Owner s Name ..- _ � A.__..�� 5�._1'\t~---•--------------- City Address �,•' . .. .... _?.me--------------------------------- -. -i License # ---------- ...... _.. Phone .-------_----------•-------- Contractor's Name . --------•-- - Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court ❑ Motel ❑ Other -------__--- ---------------- ---------- 1 1 ----------- Number of living units: - ---Privatex Number of bedrooms ------- Grinder .-_.__..._- Lot Size -...t_._..`�-___.--•------ Water Supply: Public System and name --------------------------------------------- Character of soil to a depth of 3 feet: Sand❑ Silt ❑ Clay Peat ❑ Sandy Loam ❑ Clay Loam n Hardpan ❑ 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.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) ] - Liquid Depth --------- - ---•-- PACKAGE TREATMENT [ I SEPTIC TANK Size.. 0 "` � Mate --- No. Compartments QCapacity �c --- Type' rial tr' - J -- -. Prop. Line __q. .............. Distance to nearest: Well 1�'� _ �-11 0 .....Foundation _-------- 9 �� [ l � -- �enqth of each line - �.- - -- _ Total Length .��--------------------- LEASHING LINE No. of Lines _ -__ / �M _De th Filter Material . --- -- ------------- 'D' Box _.✓_..- . Type Filter Material �_�.= P � .�� Pro er Li Distance to nearest: Weil � �`�-a�� .-- Foundation P tY SEEPAGE PIT [ j Depth Diameter Numbe- _ --------------- Rock Filled Yes ❑ No ❑ 11 Water Td�le Depth;' - ....Rock Size -------- ------------ `` '' Foundation .------ ----------. 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 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 th ,in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to beco ubject to Work)-nan's Compe sation laws of California." Signed..... .0 .✓:,�'� Owner ------- -- ----- ---------- ------------------- ----------• ------- Title ...... By (If other than owner) FOR DEPARTMENT USE ONLY — �� /:.,zX.✓� DATE --. "_l'S- `-•"----._.---- APPLICATION ACCEPTED BY �.. . -- ---•-• - _ __ .: DATE -.. -.-.._..-•------•-•----_........---•-•- BUILDING PERMIT ISSUED .--- . --- -------•----•------ .� �_ �c tit,.. '.,rv1 v1 .......• . ►"�•�......-- --"----•--.�-----•- ADDITIONAL COMMENTS --._-__-.-.-.---..••. L U .•-..__. ....... ............•---------------------------•- - --- kL ..._-.. - ------- ---- - ----- ------- - �. , ;,�, ------ Date ...... Final Ins ection b .lJ�.=__k'LL �..fL " :,"i" SAN JOAQUIN LOCAL HEALTH DISTRICT ✓,�t�_ E H. 9 1-'68 Rev. 5M