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FOR OFFICE USE: APPLICATION FOR SAI�iTATION PERMIT - - ---------------- �' 3 a Permit No. (Complete in Triplicate} This Permit Expires 1 Year From Date Issued Date Issued 37�4;- . -------------------------------------------------------- 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 --------- d ----- 11- ------------------------------------------CENSUS TRACT --------------•----------- Owner's Name `-PQ'---------------------------------------------=---------------------Phone ------------------------------------ Address ------ --- - ------------------------ City ----------------------------------------------- Contractor's Name _1 _ _ __._ _ _�____ ____ _ --------- __ _ .License # Phone _A141'7611 -_ Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court ;[] d :..-- Motel,F-1,Other -.4' _ Number of living units..--./------ Number4f}bedrooms _______Garbage Grinder ------------ Lot Size -- Water Supply':-Public System and name=------------------------------- --------------------------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ 06rdpcih ❑ Adobe W Fill Material ------------ If yes,type _______________-______-___ P (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.[A Size________ Liquid Depth ___�1P-________- Capacity J__.7a Type _ ___ __ _ Material V-9Wl1i�-4-el No. Compartments ----- -______...__ Distance to nearest. Well ------------kzl� Foundation ----/--Z)--------- Prop. Line ------ LEACHING _-LEACHING LINE No. of Lines -------/------------- Length of each line-------zwd1____--__-__ Total Length /__ lid r 'D' Box -_._�__.- Type Filter Material ------0------ Depth Filter Material ------1---------______-.--__________... Distance to nearest: Well ________--7�/ Foundation __-- -------- Property Line _____ ________________ i �/ SEE-hA, PtT [� Depth p -- Diameter W-XlQ Number ---------- -_ Rock Filled Yes W No i❑ L) YO Water Table Depth -----------l--� -------------------------Rock Size --------�__----/-----.------- Distance to nearest: Well __________ ___ ___ __________________Foundation ____1 --._-_. Prop. Line --_--__ REPAIR/ADDITION(Prev. Sanitation Permit# ________ _______________________ Date __-_________________..___.....____) Septic Tank (Specify Requirements) �� =------------------------------------- ----------------------------- Disposal Field (Specify Requirements) ______ --- v ` ---- - ------------------- /1 � / --/---------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- (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 Satz 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 Workman's Compensation laws of California." Signed ----------- -------------------------- ----------------------------------- ------------- Owner BY Title --------------'- (If other than owner[ ' FOR DA4ARTMENT US4 ONLY APPLICATION ACCEPTED B r -- -- DAT _ BUILDING PERMIT ISSUED ----------------------------------------------------------- --- --------------- ------------DAT ADDITIONALCOMMENTS .----------------------------------------------------------------------------------------------------- --------------------- ---------------------------------- x ------------------------------------------------------ ---------- --------- Final Inspection by: ---------- ----- - ---------------- --- e" Date �,� r ------------------------------------------ - SAN JOAQUIN LOCAs- HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M