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f � FOR OFFICE USE: APPLICATION MRF�SANITATION PERMIT (Complete in Triplicate) Permit No: -_7................. ••. -•-------------- 3"'�"Is Permit Expires 1 Year From Date Issued Date Issued...7 7-7JY 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: � c r �, 1 JOB ADDRESS/LOCATION a•• � ••--••-------------- CENSUS TRACT -...... --y-^ Owner's Name __SjA /� Phone ---..._- _ . . . .. AddressQ� at- tA.�. _ ....................................... City ..... Contractor's Name; j.._.'-----------------•-•------------- .......License# ... Phone Installation will serve: Residence❑Apartment House❑ Commercial❑Trailer Court Motel ❑Other.... Number of living units .-.--I_.]Number of bedrooms -__?r...Garbage Grinder .... Lot Size _. Water Supply: Public System and name ............................ -----------------------—-----------------•-• -• --- .......Private Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat❑ Sandy Loam 0 Clay Loam ❑ �. Hardpan [] Adobe* Fill Material - I4 yes,type. _-------_................. , i (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,] p� PACKAGE TREATMENT [ ] SEPTIC TANK liquid Dapih - � 01 • - Size- l �' Capacity ?v`'&Q..--._... Type a) Material No. Compartments 4 Distance to nearest: Well .--� -............t .._____--Foundation .... ---__...._ Prop. Line ...s� '. s1 LEACHING LINE [ ] No. of Lines ------------------------ Length of each line.........- -._-. Total Length _.... CJ .............. s . D' Box .... Type Filter Material - _1VC ,__._Depth`Filter Material Distance to nearest: Well ..._9�._.....-.... Foundation -------------,---------- Property Line .... -.............. SEEPAGE PIT ( ] Depth -------------------- Diameter Number ----------------- ---------- Rock Filled Yes C3 No .0 Water Table Depth ..................... .-.--Rock Size ..---.....--------........ .. _ Distance to nearest; Well _ _7: �_ _ I Foundation ..../01........_. Prop. Line ....�._- REPAIRJADDITION{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 Son 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 manner as to become subiect to Workman's Compensation laws of California." Signed . ` --------------------- ----- -- Owner 8Y �t�rV _ . - Title ............. i {If ether th caner) APPLICATION ACCEPTED BY................ .y .-- DATE BUILDING PERMIT ISSUED -------------------•----------- ------------ ---------- ADDITIONAL COMMENTS ----------------- -_ ....... --•-.........DATE ...--•---. ---- .. .. .. .. .... ----. .... ----- •- ----••••-.- ------- ----------------- . ... .. �.--Qk........-- _: _ ,,r. - -------------- - ------------------------------------ -----------------------•---- -------•---•--------..................-......... Final Inspection 6y- ---------------- ------ -. -•--•-........ . Date .- --- -------.... SAN JOAQUfN LOCAL A DISTRICT E. H. 9 1-'b6 Rev. 5M i