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.. FOR OFFICE USE: 1*.�- APPLICATION,. ,..iit�SANITATION ..MIT --------------------------- f � .T — Permit No. - (Complete in Triplicate) -- ----- - --------- ------- ----- Date Issued ' . This Permit 1 Year From Date Issued -- -------------------- - ...-- (v 9 t. .V 5- .g�14C-0 .i_mss ®5 a_ Application is hereby made lto the San Joaquin Local Health District for a per to construct and install the work herein described. This�application�made_ in compliance w_itLh�Cou�n/tly Ordinance No. 5�49la`n�/isti�sRules ACTRegulations. JO$ ADDRESS/LOCATI N ::_/---- - - --IV� N - 7-' 7 (l 1-. --- /1_K'.+"/�C�'� C j�$,ri { �� _t?. . . * rI'- - ------------------ Phone Owner's Name .-..__ ---------------.- p4 _ .. k1Q • . - _.. ...._-- '' "City . ------•---- --------------- Address -- /�. Contractor's Name ! --.License # _- ---_---------- -- Phone / J 4 Installation will serve: I` Residence ❑ Apartment House f] Commercial Trailer Court '� �t.bol�^ Vd! j E tf Motel ❑ Other----------------------------- --- -- - - Number of living units:- _ I-.._. Number of be rooms _____._-_"._Garbage Grinder .."_--- ---- Lot Size --------------------------________".._-_._. __Private ❑ Water Supply: Public Syste" and name .. -, ---•-•----•"- ---------------•----------------•-- •------------•------------ Character of soil to a depth'Iof 3 feet: Sand'❑ Silt❑ Clay ❑ Peau Sandy Loom Q Clay Loam Q Hardpan ❑ Adobe ❑ Fill Material -------- If yes,type .__._ ' IQ (Plot plan, showing 'size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.)ji NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT ( ] I SEPTIC TANK'( ] Size.....- ----------- -------- ---- Liquid Depfh ----------------------- CapacityTYPe ------ ............ Material-------- •---._ No. Compartments ................. 6G --------------Foundation -------- Pro Line _.________._---- _ i ante to nearest: Well _____________________ P• Distance - LEACHING LINE f ] No! of Lines -------- --- -__- ---- Length of each line------- Total Length ____________________-__._' - .IBox ...._------ Type Filter Material ....................Depth Filter Material ------ ------------------- J ' to nearest: Well _.---------------------- Foundation Property Line ------------------------ Distance i - - bti 1 r Rock Filled Yes ❑ No C] ,SEEPAGE-PIT ( ] ,' Depth -------- ----------- Diameter ._•___._-_•__•__ Number -------- :. 4. Water Table Depth ----- --11 Rock Size ------------- -- -- "" •c• t Distance to nearest: Well ----.--__. .Foundation ..-.__------------- Prop. Line .___..______._._ a y^ REPAIR/ADDITION(Prev. Sanitation Permit _____. -`.-.-_-----.•------------------ Dat _.__ ------- ! iii . Awx Septic Tank (Specify Req`irements) ___ _/_. s - Disposal Field (Specify Requiremen ------------------- --- ----------------- - -- � �a+?`..��`f�� ------- -- --------- - - _.....................------_ .. ---------- {Draw existing and required addition on reverse side) 1 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 Reguliatlons of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following.- "I ollowing:"I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to become subiect-to.Workman's Compensation laws of California." Sig d ------- ...- l ---- ------- Owner Title ' {If o her than' owner) II FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY __._.___._ �*� ':°l; �.:_ ._. .. _ DATE ._ . _.:a+3` ---------------- ----------- --------- PERMIT ISSUED;I --------------- DATE ADDIT NAL C M�IS�_� .7IGG�� _ . .�•p'? --- -- -- �_ .. ------------ BUILDING -- la � i� "----- • ° 3•/1 7/ --------.---.Date ....3--r.f j Final Inspection b I� SAN JOAQUIN LOCAL HEALTH DISTRICT II, E. H. 9 1 68 Rev. 5M•: