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FOR OFFICE USE: ! N FOR SANITATION PERMIT t APPLlCAT O 7 Q --------- '�`Permit No. ----- --- -- -- I (Complete in Triplicate) t --------------- p /,Date Issued Z ZS-7•w This Permit Expires 3 Year From Date Issued 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/LOCATI N .2LZ_�- , --� -- ------------- -- - -------- ------------- -- - ----:- --CENSUS TRACT -------------------------- I - -----Phone '-! ------- Owner's Name ---- -- ------- ! Y! y Address --------------- /�� -------1� ----- City - - - Contractor's Name_`------- ----------------License #`= -------- Phone �p +. Installation will ser e: Xr- Residence Apartment House-Commercial :❑Trailer Court ',❑ .. Motel ❑Other -------- -------------------------- Number of living units:_._------ Number of bedrooms ___Garbage Grinder ------------ Lot Size -_____-_________________ ._ ------------ Water Supply: Public System and name ----------------------------- -- ------------------------------------------- Private ; Character of soil to a depth of 3 feet: Sand'E] Silt El Clay ❑ Peaf E] Sandy Loam Clay Loam ❑ '. Hardpan ❑ Adobe ❑ Fill Material ------------ If yes,type ------ r (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be. placed on reverse side.) h NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) qI k PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] +�j Size---------------------------------------- Liquid Depth ______-__------- \ Y Ca-acit — r ------ - Type e------------------------ Material--i----------- ------- No. Compartments-Jr = i ---- ------------------------------------Foundation --------- -------- - Prop. Line -----E------------ pistance to nearest: Well - r , .�T . `e LEACHING LINE [ I No Lines Lines ___- --`____--_ �----- Length of each line__ *°;Total length -------------------••-••---- ' WBox'---,---- Type Filter Material :--------=- -------Depth Filter Material ----------.---------------------------- - Line ---------------•----- Distance to.nearest: Well ------------------------ Foundation .___.__-------:-------- Property F, z. 7.�a:fi-. • 4 - _______ Rock Filled Yes No '❑ SEEPAGE PIT I ] "Depth='--";•:.--�------ -; Diamet ------------- Number ---�-'-"-- ---- - ❑ Water Table Depth '----- -------Rock Size -----------------------•---- p -----------------_-- : _ Distance to nearest: Well ---------------------------• -------'Fouridat on -------- Prop. Line ----------•---------•- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date --------------------.-------------) f , _ . Septic Tank (SpecifRequirements) ----------------------------- +-- �------------------------ y P ----------- Disposal Field (Specify Requirements) -----------—------------- - 2 Ff _ ________________________________________ - - ------------------ =---------------------------------------------------------------------------------------------------------- ------------- -------- (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 I)cen- I. sed agents signature certifies the following: r "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 ------ Title ---------- ------------------------------------ ------------ (lf oth t an owner) FOR_DEPARTMENT- USE ONLYAPPLICATION ACCEPTED BY .--------' e'__-______ ------------° ------ DATE ------------------------7-�'------------ BUILDING PERMIT ISSUED ---------- -------- _ ' -------------- --------------DATE ------------------------------- ADDITIONAL COMMENTS ----------=------------- --------------- - ----------------------------------- --------------------- -------------------------------------------------------------------------------------------------------------------------------- '• ------ ------------ ------- ------ --- ---- ----- ---------- I I PY ---------------------------------------------- SAN ----------- ----- --------------------------------------------------------- - - --- --------------------- . ______ Final Inspection b pate --�' SAN JOAQUIN LOCAL HEALTH DISTRICT i E. H. 9 1-'68 Rev. 5M