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FOR.QFFICE•USE: �` "'M` APPLICATION FOR SANITATION PERMIT i t l (Compee re Triplicate) Permit No. ------------------ ...7.`�"" ....... This Permit Expires 1 Year From Date Issued Date Issued ......'7 1 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: k JOB ADDRESS/LOCATION _149.7.1....-............. . .. .... .... . __...__.._.....------_._...................CENSUS TRACT Owner's Name ........ .. _ ` one ................... .. .- ------- Contractor's ._.._.__..�©.7 --------- ....... �` City Contractor's Name _ r ` ll •- ... ----- .• p ....License # Installation will serve: Residence A artment House❑ Commerc�11..Eu:]Tlraller Court ► Motel ❑Other ._..... . Number of living units:.._........ Number of bedrooms ._' _Garbage Grinder --__ ---•--.. Lot Size ....49—.le �..._•, Water Supply: Public System and name ........❑........Silt❑ ...........Private [ .---...----•-•----------••-----------------...............•............. k Character of soil to a depth of 3 feet: Sand _Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam 91 Hardpan ❑ 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.) NEW INSTALLATION: (No septic tank or see ge pit permitted if public sewer is available within 200 feet,J PACKAGE TREATMENT i [ ] SEPTIC TANK / t Slae. ,'r.. --r�1r` ........._. Liquid Depth Capacity ..�oz_�. _._.._. Type . -----_. ._. . Material.. cJ No. Com artments ..-_1-- P �. . Distance to nearest: Well _....._, ®. ...................Faundation ........ (� prop. Line . - It f,. LEACHING LINE [ No. of Lines ....... .............. Length of each line.------- .. .-: oral Length J.,Q4.. ... C r- D' Box 7--__.- Type Filter Material .....C-R-••_--Depth Filt Material G a Distance to"nee s : Well -.._��R - Foundation _-..1Q .. .....�-. Property Line .. Tn SEEPAGE,PIT j Depth _.{ Yth _-- Diameter _.-- -- Number .._ Rock Filled Yes No-C) , -- �' Water Table 9 ___.....Rock Siie .�� jr !� `'I�. •-- .. Distance to nearest: Well . Z Foundation --z/ .. Prop. Line ... 4 � REPAIR/ADDITIONPrev. Sanitation Permit# I .,.:..... .:. Date ---•---•---------•-- Septic Tank (Specify'.Req uirem ents) ______________ . - -....-•---------•------------------------- ...... Disposal Field (Specify Requirements). ................... ........ ----- 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 W an's Compensation laws of California." Signed ...................... .. .• ... . •-- .-- -•-•- (If other t n owner) -� FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _ _ _ __________ ...... =......... •----. . .. . DATE ..A.".�`_.. = .......BUILDING PERMIT ISSUED ........................... ............. ADDITIONAL COMMENTS --•••-•---••-•-•-----•------•••.............••••-•-----•-----....----.....•---•DATE --•-----------------_------------- ..... ---•--•...... ........................•-•-------•-•--•.....-•••••---•........................•-••-•---- .........---•-- .. -r---•------•--------•--...------•---------.....--------------------•---------------•----------- ._....._...."_.-_. -------•--------- -- -- •.--- . " --•--••----••-----------•------------------ "I-------- -- r� Final Inspection b `�J`' P Y��- - - - �-• --. .. -----.. ---••................•----................................................Date ..._... ---.. .---............. ._.._. SAN JOAQUIN. LOCAL HEALTH DISTRICT E.H. 1.3 241-_68 Rev. 5M