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FOR OFFICE USE: APPLICATION POLI SANITATION PERMIT 3 S� .........---•.................................. , Permit No. ..75_...... ... {Complete In Triplicate) y = ............... :...... Issue3_ 7S Date d .....'............. .................. ........... ......... This Permit Expires ] 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 i described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: ��..9�.2...�� ! i?� . .................. ....CENSUS TRACT JOB AbbRfSS/LOCAT#O / a � ' Owner's Name �- s �� on ................... i ...... Address . . ...... U a . . ............................... City . 2-- Contractor's Name ...............License # ......... .. .... Phone .......................... Installation will serve: Residence[/Apartment House Commercial ❑Trailer Court 0 Motel ❑Other ..................•-----.. ................ Number of living units:...... Number of bedrooms Garbage Grinder .... Lot Slxe ......---•-•....... ..................... Water Supply: Public System and name .... -•------------------------- ..........................._............................................Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat-0 --Sandy-Loam-0 - Clay Loam 0 Hardpan W Adobe fl Fill Material ............ If.yes,type ............... ............ I (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, or see age pit permitted If public sewer available within 200 feet,) PACKAGE TREATMENT I I SEPTIC TANK{/7 Size. .�.1 ..L tC••.a�•�••••-••• Liquid Depth ..4/............... Capacity mo-,P— _ ._ Type p .... Material...--- No. Compartments Y........:....� Faundcs#ion fes' ...... Pro Line i Distance to nearest: Well .. '.-----_... :. � p / r n LEACHING LINE [,] No. of Lines .__...- :---_-:----. Length_of.,each_line-T... �-/".--..... Total Length, ..��-a-.�-r -••••• J - ' , ' sr f 'D Box ---�•�------ Type filterTMaterial. ...-Ye�.__Depth .Filter Material ......�..�1.................. • �� sT Distance to nearest: Well .......5;V.: -•-"Found.tion ....�o-- -••------... Property Line .......... -•- -........ S' . Number ............—23 Rock Filled Yes [ No 0 SEEPAGE PIT [� Depth ....�-_...� Diameter _......._ . � Water Table Depth ...........L.9_'V_.1--------------------Rock Size -...X.. ....._._ Distance to nearest: Well ..........LQ-AV...0..-f..........Foundation .-�4.� ------- Prop. line .... . REPAIR/ADDITION(Prev. Sanitation Permit# ...:-------------..-------------------------- Date --•-----------------••-•---•-.----) Septic Tank (Specify Requirements) ----------------------- .....................—............................................11-................. •-------• O' { Disposal Field (Specify Requirements) -------------------------- •---------------.....-•---------•-----.........----------------......----....---......---•--.....---....:. -=-------------- ------• ------------------------------=--...----•---•----------------------•-•----......... -----------------------------_......................... ............................................................. - L (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be clone In accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health.©istrict. Horne owner or IIIcan- sed agents signature certifies the fallowing: - f "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 laws of California." Signed _-----------•----...- Owner ---- ..-- ---..... ------------ 6c- �- ------ title -... '... (If other thanowner) t FOR DEPARTMENT USE ONLY 1106 APPLICATION ACCEPTED 6Y ..'_. ---.... DAl -..,..._C 4 s:� ------ - BUILDING' PERMIT ISSUED ------ ---------------------------.-------------------------.--------------- --•---------- - ---.DATE .. --------- -----• ....................... ADDITIONALCOMMENTS --------------=---------------------------•--- ........ ------------- --------- ---------------.:.--------------............ - -- -- ---------------------- ... ._ -------------------- ----------....... ....................................... .,,. ........ . ....------- --final Inspection by- ---------------------------- •--•---•-- ........................---.........-- ...,..Bate .. .�: f i ' EH 13 2h 1-68 lav, 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M