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FOR OFFICE USE: OPermit ------------ APPLICATION ICOR SANITATION PEMUT(Complete in Triplicate) No. ................. •---...... --- _..� �....._ This Permit Expires f Year from Date Issved 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: JOB ADDRESS/LOCATION .r► .Fi.�Q. ...�....l,V'C. PS__.._C l...._._ . 'l1RsN +91 v ...............CENSUS TRACT .......................... Owner's Name .N%. ft+& Vv .....................................Phone....................,................ Address . ......-- 0'..._. . ....................•-.........City ....... ...................... .�Contractor's Name Qa ......... .......License # e,......... Phone ..�_�a �-A.��.�........ Installotion will serve: Residence ApartmentHouse ] Commercial OTrailerCourt Cy. --., -Motel E]Othii —, ... ........ ............................. �.. _ r Number of living units:_._ ._'_2:_ Number of 3bedrooins `_._"":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 SK -;, Prr.._ Hardpan ®_-Adobe O,, Oi-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,) PACKAGE TREATMENT[ ] SEPTIC TANK,[ ] Sizesix S ........ ............. Liquid Depth .......... G(1j ;Capacity /tayW_ Type&a. . Material..LIF' ... No. Compartments . ............ :.... Distance.to nearest: Well .. .......................Founda tion .�!). ............... Prop. Line� 7�:.... C LEACHING LINE S. of Lines -4a------------------ Length of each li e..)60._..... ...... Total Length ..... .....•........ D' Box ...1------- Type Filter Material I.il-.•lAb`k-Depth Filte � Material ./�................................ ... Distance to nearest: Well�o-4-_ ----- Foundation �.. .7- . . .. . Property Line G.-t........ .... SEEPAGE PIT [ J Depth X-------------- Diameter IM.7w...... Number ..a?------------- Rock Filled Yes No �} Water Table Depth .......................l.]....... ..............Rock Size ...../ .................... Distance to nearest: Well -��_ T_ c!d--------•. .......... ... .....Foundation _ -- Prop. line al".- .r....-- 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 Lawns, 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 i as to become subject to Workman's Compensation laws of California." Signed --- -- ---•-=• -- Owner • • , BY a# . Title . ...... ..-.--•--•------ (I other t n owner) R FOR DIPARTMENT USE ONLY 4 APPLICATION ACCEPTS© BY -- ------------=----- ----- DATE ...Z ILDING PERMIT ISSUED -------- •- -------DATE ------------ ............. ---------- ADDITIONAL COMMENTS _._': .-:.._. -- s -.?: iso-t --` . .......... .... :-:----- --- ------------------ tom'--' -:f f'i: ::. _:: ' ------------------------------------------ ----- ....----................. ......----------------------------------------- Fina! Inspection by . •... .........Date ......... . _l b � lH 13 2h 1-68 Rev. SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3m