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FOR OFFICE USE., LICATIQN FOR SANITATION PERMIT - ....................................................i Permit No. ..7 �n Pub tCompiefe in Triplicate{ ........................................................ _ ? �A� hls Permit Expires II Hear from Date Issued Date issued .. ."._.::...... j Application is hereby ode to the So Joaquin Local Healthistrict for a permit to construct and install the work herein descr7DE . hi tion is a IB com is co with Cov ry Ordinance No. 549 and existing Rules and Regulations, JOB /L T!O /. ............... ...... . .T f.....,..._....... . CENSUS TRA .................... Owner's N e ... .. ........ ........,......,............_............ ..._......Phone ....._..................... ... _ ...... Address .� -- • - -----•-•-------- ----------- -- ............... City ... . ..................... Contractor's Name:. .....moi..............License #,15_R.:SRrj ._ Phone .. s��...Y..7"J?. ?fo s Installation will serves Residence Apartment House❑ Commercial ElTraller Court ❑ Motel ❑Other Number of living units—]------ Number of bedrooms ._....Garbage Grinder .. .. Lot Size ... .:.........:.... ...... Water Supply: Public System and name .................... Private. Character of soil too depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peot❑ Sandy Loom o Clay Loam ..-, Hardpan,,, Adobe 0 Fill Material ............ if yes,type n.......................... .- --Jl (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 f ] Size..... 1 �p®/�............. ......... liquid Depth .......................... � Capacity ----------- -------- Typed.._.._._ Material..[. Na. Compartments ....?...... F Distance to nearest: Well ----------Faun ation ._J!il0..*......... Prop. Line ... ......... LEACHING LINE [ ) No. of Line _-- , ,.----...---- Length of each line-...:.. ..r/............ Total Length ....�............. 'D' Box . .. 5.... Type Filter Material eVAC.....Depth Filter Taterial Distance© neq esh ell.Awl .. ...__�Foundation 40..*.......... Property Line ....+�� _.. . # ) Depth !.. /.. iiwsx+Irer (� 1 Number ....._A+ ............... Rock Filled Yes No i❑ .rot"WA Water Table D pth 2 r� = =••-•.............Rock Size .�..�i.--~......----••. f Distance to nearest: Well .�ONO--- ..... . ..............foundation ..... Prop. Line .....�...�'.....-_C REPAIR/ADDITION(Prev. Sanitation Permit# _............... ...... .._...__.. Date o� 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: "1 certify that in the performance of the work fa which this permit Is issued, I shall not employ any person in such manner as to bec esu je to rkm Corn ens laws of California." Signed . .-• ..................................................... Owner BY ----. xitle .- .1. p ............... If other than owner) FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY ......................................................... ..................I.......-._..... DATE. .................................. BUILDINGPERMIT ISSUED ---•................................ ............................._........_..__:.::...------------_-------DATE .... --------------------------------------- ADDITIONALCOMMENTS ............................••-------...-----.....-•---------------._.....-•------- ...................................-........'...:........................... . --............................ • • •. ---.. ...... ........_....................-. ..... .......-.... .............-... . ....-_..... ._. ._.. ...... .... ............................................................. Final inspection by: _-- ...............Date, ..; _ �......---._...... EFl 13 24 1-68 Rev. SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h. 3M