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FOR OFFICE USE: F APPLICATIONIFOII`SANITATION PERMIT 3 Permit No- --------------------- ------- =--------- --------- --------- -------- --- (Complete in Triplicate) _ -----i----- ------------ ------------ ------------------ 11 Date Issued =7� 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: �� ---: '---- -- � -- - --.- - - NSUS TRACT -------------------------- JOB ADDRESS/LOCATION - -- - --------�p' -----------------�-��•______ __ -----Phone Owner's Namey �y City - - • , Address _ __/. 1� � 4.4 '- 9 �G - __ ` Contractor's Name _- - ----------- License # + -/-&.-- Phone _la Installation will serve: Residence �Apar t House[] Commercial ❑Trailer Court l❑ Motel ❑Other -.----I--------------- ------------------ Number of living units:- ------ Number of bedrooms _3-------Garbage Grinder _lila---- Lot Size --"" ---- + r Water Supply: Public System and name ----------- - �----- ---------------------------------------------------------------------------Private ® 1" � Character of soil to a depth of 3 feet: Sand'[:] -Silt❑j Clay ❑ Peat❑ Sandy Loam F1 Clay,Loam ❑ J Hardpan Ado b� ® Fill Material ------------ If yes,type ---------------------------- (Plot plan, showing size of lot, location of system in rlelation to wells, buildings, etc. must be placed on reverse side.) f11 NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) i I/ Lf PACKAGE TREATMENT [ ] SEPTICTANK.� � Size---�-i--�-----X----9--_�----------- -- -- - Liquid Depth -------------•-- �Gi aterial_-_--------- ---- o. Compartments ---�--_-_---.-.-- a Capacity _A,)0.0------ TYP�-- --•- �+ yUn_4?�I'x.li!t&J ------------Foundation ---I-0 Prop. Line Distance to nearest: Well ,�! -- /��1 LEACHING LINE 50 No. of Lines .------ � I? --- --------- Total Length -- --------••-----------•- off______-_____ Length of each line_____ -- g 'D' Box 1''�__-__ Type Filter. Material ___r-- ---"_--_Depth Filter Material ------- ----- ---- i - - ---- , i , Distance to nearest: Well _ _,, -`2.0--- Foundation ___---1 Property Line - � off•--------------- --- Rock Filled Yes .M No ❑ ( SEEPAGE PIT [ ] Depth ---1�._.-------- Diameter �YLc�__-- Number ---- ------- Water Table Depth ----- ------ I------------------------------Rock Size -------------------------------- Distance to nearest: Well .� ----�faC�--f_Foundation ----� U------- Prop- Line _ REPAIR/ADDITION(Prev. Sanitation Permit# -------- ----------------------------------- Date ------------------------------ ----) 1 Septic Tank (Specify Requirements) - ----------- -------- --------------------------------------------------------- Disposal Field (Specify Requirements) --------------------- ------------------------- ------------- ----------------- ----------------------------------------------------------------- .. -------- ----—--------J---------------------------------------------------------------------- ---------------------------------------- � {Draw existingand required addition on reverse side) p I hereby certify that I have rep ared 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- f - 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( law sf�of California." f. Signed --- �ff ----.---. Owner r ✓ a I� ---------- Title --- (If other than owner) FOR DEPARTMENT USE ONLY - - -------------:111---------------------------------------------------------- D �TE ��- APPLICATION ACCEPTED BY DA ----------------------- - - BUILDING PERMIT ISSUED ----------------------- I ----------------- ------- COMMENTS ----------------------------------------------�I---- --------------------------- - i -------------------------------------------------------- �I ---------------------------------------- ------------------- -- --- ------ +� �j - Final Inspection by: _ - --- -- --------Date - --- ---r --- i SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M -