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FOR OFFI E USE: APPLICATION F61'SANITATIONh� -- -��- --------`_�-�---_rte PERMIT Ay �! [Complete in Triplicate] j i Permit No: . J _______________ _ _ _____________:_______-_ �---- This Permit Expires''! Year From Date Issued t! Date Issued Application is hereby made to the San Joaquin Local Health District for a Pp Y q permit to construct and install the work herein described. This applicationis made in compliance with County.Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION :.�__..____ �_ •- - ------ --------- CENSUS TRACT __ � _ � ------------------------ Owner's Name --------)7 *------- Phone Address - --- ------ City ----------- Contractor's Name -------- --- M' ��----- j �---_-------.License #a ' - --._ --- Installation will serve: Residence ❑ Apartment House Xcommercial ❑Trailer Court 0 Motel ❑ Other Number of living units:-.2 Number of bedrooms _Garbage Grinder __CJ__ Lot Size _--_41,_ ------ _o7_U_____ �Q i Water Supply: Public Systerii and name --------1� --r- ----------- ------------------------------------------Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Si It Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam 1. Hardpan ❑ Adobe X Fill Material ------------ If yes, type ___________________________ + (Plot plan, .showing size of lot, location of system in r'elation_tc wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: {No,iseptic.tank or se age it permitted if public sewer is available within 200 feet,] s PACKAGE TREATMENT [ ] SEPTIC TANK Size-------------------------------------__--------' Liquid Depth ____.______________-___._- = Capacit �_`__ _k___-_____ ___ No. Compartments -----------------=---- k.Y Type` Material - i,; a Distan�e two 'nearest., ;Well -------------------'---------------Foundation ---------------------- Prop. Line ----------------------x � LEACHING LINE [ ] No.,� of,.Lines Xl_ _-?'_C�6Length of each line_______ ______________ ___- Total Length ,__________.__...--_-___-- 0 - 'DBox..._- ___ ___ Type Filter Material --------------------Depth Filter Material ( ' �. Distance to nearest: Well ________________ SEEPAGE PIT Foundation "----------___.__._____ ... Property Line ___.__ .._____._._.___ + ' I� I' I ._Depth S=_f______ Diameter __ ___ ----- Number -----------!_ _ C. __.___ _____ Rock Filled Yes �` No 0 - Water Table Depth --- -- � _---- ---------------------------Rock Size ---- ------ --r--------------} y 4 I Distance to nearest: Well _�✓-- __ __ A"-_Foundation ___ 11(7--------- Prop. Line ------ 'REPAIR/ADDITION(Prev. Sanitation `" tation Permit# -------------- s r----- ----------------- Date -------- -----1 �`• Septic Tank {Specify Requirements] /��C ------ -----`- d � •C-'--__ t_T ...... r . P e/ q Disposal ,Field (Specify Requirements) - : - � -------X3.2-4--------- -k- ---- t ri 'b, i f ----------- ----------Ai� ... .. A j� ; 1. -------------------- k (Draw-existing and required addition on reverse side) 4 I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin fi 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 manner as to become subject to Workman's Compensation laws of California." Signed iI--- ------------- -------------- ------------------------------ Owner ] BY .------ Title --------- - ' (if other than owner) I� FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY ___-_/_--- ---- - -------------------------- DATE 3 , - -------i. _vr/- € BUILDING PERMIT ISSUED -:4-------------- _--- ---------- --------=--------------DATE ------- ---- ------ ----------------------- ADDITIONAiCOMMENTS 0--------------------------------------- --------------------------------------------------------------------------------------- --------------------------- ------------------------------- =i N--------------il---------- - ---- - --- -__- ----------------------------- ----------------------------------------------------------------------------------- ,r --- -------------- -------------------------------------------------------------------- ---------- ------------------------------------ ---- ----- Final Inspection by --- --7�-�----------------------------.Date --- ---- --------------- ' ' SAN JOAQUIN L CAL HEALTH DISTRICT E. H. 9_ 1-'68 Rev. 5M