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. FOR OFFICE USE: # 7il /OSS (Com OR SANITATION PERMIT APPLICATION L _. .. , 4..............�'. :.,��...._. Permit No. .. 5 plete in Triplicate) !ill This Permit Expires i Year,From Date Issued Date Issued .. .............. a 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 jCounty Ordinance No. 549 and existing Rules and Regulations.. JOB ADDRESS LOCATION L ...... "?`,!�E. ... ...._ ........CENSUS TRACT .......................... Owner's Name ............... Fokf ....!;%k_ewc-9._..•......__......_..._......,...................._................ ....... Address ........................................ -------........................................I............. City ..---'�A5'k ................................................... Contractor's Contractor's Name ?.S.�fl-.----4_... ......................License # ... Phone Installation will serve: Residence Q0 Apartment House,0 Commercial []Trailer Court i❑ E +Motel 0 Other ............................................ Number of living units:.......... Number of bedrooms .�?.....Garbage_Grinder........,..... lot Size . . .. ----------------- Water Supply: Public System and name ...............................•---- -- Private t Character.of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑,I Peat❑ Sandy Loam,:❑ Clay Loam 0 - Hardpan -Hardpan ❑ Adobe 4 Fill Material ............ If yes,type ._..----__---.--• ------- (Plot ---(Plot pian, showing size of lot, location ofsystem in relation to wells, building-s�etc must°lie placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted If public sewer i ailable`with1w200:feet,) PACKAGE TREATMENT" [ ] . SEPTIC TANK[ ] Size.------.,-.......................•--- -.._ Liquidt•Depth ..._ ..................... Capacity .................... Type -----.-------___---- Material----------- No. Compartments Distance to nearest: Well -------------- --- ------ -------------Foundation ...................... Prop. Line .... ................. LEACHING LINE [ J No. of Lines ________________________ Lengthlbf each line ........... Total length-A:�__...................._. 'D' Box Type Filter Material .E................`Depth-Fitt r-1Vldte`ria1 ----------------------------------- Distance to nearest: Well -__._._.-__--..._-_-_ Foundation ........................ Property Line s SEEPAGE PIT [ ) Depth -----------•-------- Diameter ................ Number ---------------------------- Rock Filled Yes 0 No I❑ Water Table Depth ............................................... Rock`Size ................. •............. ? Distance to nearest: Well ........................................Foundation .................... Prop. Line REPAIR/ADDITION{Prev. Sanitation Permit# .............__............................. Date ... ............................_.) Septic Tank (Specify Requirements} I----------- ..:.............................._.__...--------.----.._..__...._ ^I. Disposal Field (Specify Requirements) ..._.. .-._ ._. !. ?...... .... .. . a .. x mss' d ...�°�s (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: "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 Work n's Compensation laws of California." Signed ---------- ---- -- - ----------- - --------- {--------- ------ -I--------------------------- Own BY �... ..._ Title ........ .J....................................................... f other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .......... .'..........•-••...............................................................•--_..... DATE . . ..- .`lr__7 ._...-.--------. BUILDING PERMIT ISSUED .. -------------------- ••--•- ...-. -- --- ------------- ............ ........................ .................. ADDITIONAL COMMENTS ..�e�� y 7 ,f - -._ ""�..-..:........................ �� ; . ��. ------- -• - �� r ._..--.. ... ..................•-- Final Inspection by: ................ .......... ......-- ...........Date .Z ..� ...._:..._. i W w ry SAN JOAQUIN LOCAL HEALTH DISTRICT i, E. H. 13 24 1-'68 Rev. 5M 7/723 ,14 ;