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FOR OFFICE USE: APPLICATION FOR, SAN_1TATION PERMIT ------ --- Permit No. � ----------- - --- - {Complete in Yriplicatel ------------------------------------ --------- - ---------- ------------------------------------------ Qate Issued ------------_-- This Permit Expires 1 Year From Date Issued a 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 AbDRE55/LOCATiON / cic , - -- ' SvCENSUS TRACT ----- - - ------------y (�` y� Phone 6 Owner's Name ---`- w--/n�a�z5;1w------6---•----------------------------- - ------- - --- ---------- Address ---- � c �aAllir-.:�.�/------ ��---------=------------------------ City . arI z-C.C' -r Contractor's Name __ , Z'----------------LicenseKra # . S f —3-- PhoneInstallation will serve: Residence ❑ Apartment House,❑ Commercial iler Court ❑ ' Motel ❑ Other ----------------------- Number __ -------------Number of living units------------- Number of bedrooms ____________Garbage Grinder ------------ Lot Size - - - -��--'--- Water Supply: Public System and name _____________________ ___ t _____Private - - - Character of soil to a depth of 3 feet: Sand Silt F] Clay ❑ Peat❑ Sandy Loam ❑-f Clay Loam [] Hardpan ❑ Adobe ❑ Fill Material ----- ------ If yes, type------------------------------ 4 _____________1__ --- r (Plot plan, showing size of lot, location of sysf&rn 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[] ^^-- Size.-- _X_-C�- 1�?_______-------- Liquid Depth ------S_-3------------- �w �-•-•- Capacity ___� ?_+�____ Type -- .zJL' t�Material---------------------- No. Compartments Distance to nearest- Well ------ .a`Z`3-----------------••Foundation -----/L?______.___ Prop. Line ___. ----------- LEACHING LINE [ ] No. of Lines --- �---------- Length of each 4 -0line------ --Q----____- Total Length-___14?A0_____....... __ 'D' Box �1---- Type Filter Material friX__�----Depth Filter Materia! __________Af -------------------------- k f,. i Distance to nearest: Well -----/15`V-________ Foundation ____/d____________ 'Property Line ---4�------------- SEEPAGE PIT [ ] Depth _f_________________ Diameter ________________ Number _______-----_.______------ Rock Filled Yes ❑ No 7❑ A WaterTable Depth -----------------------------------------•------Rock Size -------------------------------- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ---------------------- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ____--__________------------------) SepticTank (Specify Requirements) --------------------------------------------------------------------------------------------------------------- ---------------------------- Disposal Field (Specify Requirements) ------------- ---------------------------------------------------------------------- -------------------- ----------- ! --------- ------------------------ ------ -------------------------- ---------------- ----------------------------------- ----------------------------------------------------------------------- -- ------------------------------ I (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 San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: t "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 becom blect t. Workman's Compensation laws of California." Signed ---- ---- -----------. Owner BY •--- ------- Title _.__ A --- - - ------ (If other t an ner) FOR DEPARTMENT USE ONLY / APPLICATION ACCEPTED BY. _..: --------------- DATE .. . BUILDINGPERMIT ISSUED ------*------------------------------------------------------------------- -------------- --------------DATE ------------- ----------------------- ----- ADDITIONALCOMMENTS ------------`-7----`7--=------- --------k-------------- -------------------------------------------- ------------------------- -- •------------------ . ._._ . u . ________________________________________________ __ _ _________ Final Inspection by -------------------------------------------------------.Da#e .- .-�9= � SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M