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FOR OFFICE USE: APPLICATION ICOR SANITATION PERMIT ...... (Complete in Triplicate) Permit No. ..................... Issued .. ZS " This Permit Expires 1 Year From bate issued Date .:. - 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 ...... . .a1•6—,,57 '' < CENSUS TRACT Owner's Name ............. .......................... Address ... r / C ne .� ....... ...... .. ..................... ......._ .._ qty 4 Z,' Contractor's ............... ----................................. o s Name. -� ' -------_------------License #i a Phone _ 1� installation will serve: Residence y Apartment House 0 Commercial❑Trailer Court Motel ❑Other ----------------••-- ............. Number of living units:--.-/---- Number of bedrooms -____.--- Garbage Grinder ..____-_.___ Lot Size _____________________ Water Supply: Public System and name --------__.......................... f _ ..............Privatex Character of soil to a depth of 3 feet; Sand ' _ b Silt.E] • clay '❑ Peat❑ Sandy Loom' G9 Clay Loam ❑ Heed an _. ❑ p [ Adobe F€I Material ..._........ if yes,type-•--••.•--__-•- •- 1Plat pian, showing size of lot, locatigri'of system-in)relotion 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- f-I—• SEPTIC TANK � i Size. Liquid Depth .... Capacity A ----------- YYpo ------••------------ Material---------------------- No: Compartments ...._................... Distance to nearest: Well ------------------------------------Foundation __-_-__.......--_--... Prop. Line ..................... r LEACHING LINEN No. of Lines -.--.-..._-- `..__. Letzgth of.each line..------ ---------• --•-- Tgtat Length ............................ M�. ..�__ .............. 4- _----Depth Filter Material'D' Box Type Filter aterial ............................ Distance to nearest: Well ---------------•........ Foundation .. Property Line SEEPAGE PITDepth ----•------- ------- Diameter Number ....................... Rock Filled Yes ❑ No �]? 4 ._._.�- -,-Water Table Depth ..__:_""._. - ' '' �• ---- --- -- - ----Rock Size ..---....-• �► Distance td nearest: Well ---------•------•----•------------------foundation .._-__....___..----- Prop. Line ........__:._._.. .. 7 I REPAIR/ADDITION(Prev. Sanitation Permit ---t..--•------- ----------- Date ...............• ) f Se tic Tank i '^ a P pacify Requirements) _........ .......................-----------------------........................... i 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 Jooquin local Health;District. Home owner or licew sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, 1 shall not omploy any person in such manner as to become object # o man's C mpensation laws of California.- Signed caner Signed - - -.-- _ . .. By .......................... ---------------------- -- ---:.. Title ..% '= (If other than owner) ...---- ------ FOR EPARTMENT 'USE,ONLY- ' APPLICATION ACCEPTED BY _.... DATE ..._ _-- BUfLDING PERMIT ISSUED . ------ -------- BUILDING - ADDITIONAL COMMENTS ---------------- ---------- -- - -----------------------------------------------� ...-------� - - - DAT E ---------------------- ................•--------.........--.__... ---•-• •----•-- -.. •-----.------• ------- ----------•-----_..._--- ----��---- -- -- -- - --------�------ ._._...------._....---...-----�• ----��----- final Inspection b --••- • -• -------- -• � .. Date ._. ----- E ...�/.�.c--'I-�...----• H 13 2!t 1-68 Rev. 5m - -- ---------- ---------•_--------�----...__._. ------ ._. _. SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7-h 3M