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FOR OFFICE USE: APPLICATION .FOR 5:t.,NITATION PERMIT Permit No: _-_ ` --------lj -�D------` - -- ------ -------- (Complete in Triplicate) -------------------------•------------- -------- --- f Date Issued /49:7�-l0-==�3 This Permit Expires ] Year From Date Issued F # Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: ` --- CENSUS TRACT -------------- ----------- JOB ADDRESS/LOCATION . 1-- r� �L�1 � �y q Owner's Name ----��/ �-S ----- &L� � ------ # --------------------Phone Address --------- ��7�----- L ------- ------ City ---------------------------- Contractor's ----Contractor s Name ._/ � - ---- ' License ,7 __- _Rhon j- Installation will serve: Residence XApartment House❑ Commercial :❑Trailer'Court ;❑ Motel ❑ Other --------------- [Number of living units:---- -�.._ Number. of bedrooms,___,Garbage Grinder /.10--- Lot Size; ------------ Water Supply: Public System and name - Privates ] C haracter of soil to a depth of 3 feet: Sand❑ Silt{] Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam;❑ Hardpan [r Adobe Fill Material ------------ If yes,type --=------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.} ' p seepage pit permitted if public sewer is available within 200 feet,) NEW INSTALLATION: (No septic tank or •� _ PACKAGE TREATMENT [ I SEPTIC TANK Size_ A� .�L` --- ------- Liquid .Depth __�--------------------- TypV??34- Compartments - -.---------_•-•- Capacity�C� TYp r Distance to nearest: Wel --------------------------Foundation _ �_ _ _E___'_ Prop. Line __ "------- LEACHING LINE No. of Lines -___ ______________ Length of each line------- -- S Total Length - ,7f1r _ r D' Box _y.�. Type Filter Material _,�ji�•AC_.Depth Filter Material' _ --- ----- --•. _ Foundation --/A--- Property Line - ----------.---------- (� Distance to nearest:,Well _.__ -- ---- - i � n, r /r s SEEPAGE PIT �(J Depth --- 5. --- - -' Diameter at _------ Number ------- .--f---------- Rack Filled Yes Na �] i/.� r c , Water Table Depth'—<3_60; �------ ---- ---------°--------Rock Size - - - --- � -f --------=-- Foundation --1 ___ ------ Pro Line---� ----_------ REPAIR/ADDITION -- --- Distance to nearest: Well _,lD©------------------------------- p' -' j� REPAIR/ADDITION(Prev. Sanitation Permit# _.------.------.---------------------------- Date -------------------------- '----) ------------- Septic Tank (Specify Requirements)-'-------.----------------------------------------------------- '"-` Yf Disposal Field (Specify Requirements) ----------------------- -------------------- ----------------------------------------------- ---- -- - - - -------- ---------------------------------------------------------------- ------------------------ --------------- -------------------------------------------- - - -- - -- - - ------- ------ . (Draw existing and required addition on reverse s d e} t 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 perfarmance 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 Compens tion laws of California." Signed --------------- ------ --- ------------ - ------------------------ Owner ----------------- --------- t _ title ------ ----- - ---- ---------------------------- Jif ---------- ------------ - (!f other n owns F R EPARTMENT USE NLY APPLICATION ACCEPTED BY ----- -- ---- ------------------------ DATE -r Q BUILDING-PERMIT-ISSUED__- ___- '------- ---_=------------ '= == : ,,-_:_ -----;, ------------------ I ADDITIONAL COMMENTS ----- --- ---- ------ -------- ----------- - -- j� f7 - ----------- 1-10"----=-- --------------------------------------------- - _____________ __________________________ P___.--________________-________._____________ ____________-_ ____ I ----------------------------------- Final Inspection b � ---Date - �---- ------ -�-- --SA----- ----- - ' N JOA IN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M