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FOR OFFICE USE: APFi1 A ON IF R SANITATION PERMIT --�-L�k�-- :, Permit No. (Complete in Triplicate! --------------- p Date issued This Permit Ex ires 1 Year From Date Issued A lication 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: ------------------- ------CENSUS TRACT ------ ----=---------•---- JOB ADDRESS/LOCATION .__ _� ......... . C�/S- � - ----Phone Owner's Name - �C `�=="-' Jf ----- Address - ---- --- --• city � or--_7---------------- ----------- - -------------------------------------------- - Contractor's Name _.. r� "r � ® �-------------------------------License # t �1 Phone 1 Installation will serve: ResidenceXApartment House❑ Commercial ❑Trailer Court ;❑ Motel ❑Other ------------:--------------------- 'f . Number of livingunits:--/ Number of bedrooms �_____Garba e Grinder � - Lot Size ` ------Private$ Water Supply: Public System andname , J Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay + Peat ElSandy Loam ❑ Clay Loam,❑ Fill Mate i 1 -------.---- If yes,type ------ Hardpan E] Adobe � � ----" - """ -------- (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,}00, ' ` `k SEPTIC TANK Size-_ ---X. Liquid Depth ` ;--•--- PACKAGE TREATMENT -[ ] O ' Materials---- No. Compartments ---_----••------...,.. Capdcity,� - - TYp -- - � � � mob` - - --- O Foundation -- _-� ------ Prop. Line Z,j --------- pistance to 'nearest: Wel ZF- — --- j LEACHING LINE No. of Lines -------------- Length of a ch ine___-_ --------- Total Length 1,7e---------------- f A F r ^~` e th Filter Material � � D' Box _ �TYpe F+Iter Mat�erEal '--- p �� j Dista a to nearest: Well -i---- Foundation ___ l Pr.p-rtY >Line --------•- 5 y V - �" Diameter „- __� ^r-Number ______ '- ------------ Rock Filled Yes01 W �No �C i SEEPAGE PIT Depth ---- --- / �—A id Water Table Depth __ RoEk Size -- y - ----------------------- - n ,.� -------Founda ion �-------- Prop. Line � ---•----- - -------------------------------------- Distance to nearest: Well __�--_ ------- - _ , REPAIR/ADDITION(Prev. Sanitation Permit# ---_---- - = --- Date•-------------------- -----------) ; r Septic Tank (Specify Requirements) -------------------------------------------------------------------------- - -- l 1 ' ------------------------------ ------------- Disposal Field (Specify Requirements) -------------------- °--------•-- --------""- t ---------------- --------------------- I -------------------------------- r 4 r `a - -------------------------- (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: A "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 Compensafiii.on laws of California." Signed - ---- OI ne --' ------ --- r �"7~ By ----------------------- (if _ .� an owner) l FOR DEPARTMENT USE ONLY ' r f_ APPLICATION ACCEPTED BY ...L! - ---- ---------------------------------------------------------- DATEDATE BUILDING PERMIT ISSUED ------------------ ------------ ADDITIONAL COMMENTS ------------------------- ------------------------------------------- - - ---------------------- ---------------------------------------------------------- ------------------- - ------------------- � � If---------- ----------------------------------------------- - -- Date -- 7 Final Inspection b --- ---------- -- •�i5/NSA �0 5-77i SA JOAQUIN aLOCAL HEALW DISTRICT A77## ,,t~. c.X.s� E. H. 9 1='68 Rev. 5M