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FOR OFFICE USE: APPLICATION F61Z SANITATION PERMIT - Permit No. S3__ -- -----------------------------4�,�`" (Complete in Triplicate) `%` Date Issued�-_-�____.._ - -------------------------------_-- This Permit Expires 1 Year From bate 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: L *: �� '- CENSUS TRACT l L/ �__ } JOB ADDRESS/LOCATION -- --------------- 4. Phone -- Owner's Name !� �—QE7 ��----------Cit Address --------------------=--- --------- Y ` ---------- --- Contractor's Name ------------- -- --- ---i g�7�'-'---------=-------License #/QZ2�/I------._ Phone 4- '� ---------- Installation will serve: Residence-Apart e t House❑ Commercial;❑Trailer Court ',❑ : t Motel F1Other.4-------------------------------------------- / Number of living units:-----(__---- Number of bedrooms __2�arbage`Geinder ------------ Lot Size -------- Y----------- Water Supply: Public System and name ------------ ---------•----- :--•---------------------• ------------------- ----------------------------------Private Character of soil to a depth of 3 feet: Sand'[] Silt❑ Clay ❑ Peat.❑ Sandy Loam_- Clay Loam ❑ --'1�. a Hardpan E] Adobe'❑ FiII�Mafierial ____ - <If yes,type ___________________________ I ti (Plot plow'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 perrnitted-if:public sewer is available within 200 feet,) PACKAGE,TREATMENT ( ] SEPTIC TANK'[ ] Size ----=----=------------------------------ Liquid Depth -------------------------- 1. Capacity. Type -------------------- Allaferirgl,:� ------ No. Compartments -------------- ------- Distance to- nearest: Well ------------------------------------Foundation ---------------------- Prop. Line ---------------------- LEACHING LINE [ ] No. of Lines ------------------------ Length of each line--------------------------- Total Length ------.----.-------......... C 'D' Box --------- Type Filter Material --------------------Depth Filter Material ----------------------------------- ........... Pation ------------------------ roperty Distonce'to nearest: Well ------------------------ FoundLine ---------.__-----..----- II SEEPAGE PIT [ ] Depth _--- Diameter ________________ Number ._.__._____-----____________ Rock Filled Yes ❑ No I❑ - - ... ._ } WaterTable Depth ------------------------------------------'" ..----Rock Size -------------------------------- >. Distance to nearest: Well ----------------------------------------Foundation ----------------;-- Prop. Line -------------- ------- REPAIR/ADDITION(Prev. Sanitation Permit# -.--' �., � --•------ ----------------- -- - - Rat c----------------'------------ l Septic Tank (Specify Requirements)-_--t - -- k,---- ---- -- -- - ' --. = ,. - Disposal Field (Specify Requirements) ------ ---- __e - --------------------------------------------- r"x t.rte- -----------.--- -..----------------------_---•---------- ----------------------------- -------------------------------------------------- ! z ---------------------- } ----------------------------- -F------------- {---------------------------------------------------------------------------•---------------------------- (Draw existing and required addition on reverse side) �. .1.� �y 1 hereby certify that 1=have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws,iand Rules and Regulations of the San Joaquin Local Health District. Home owner or liven- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, 1 shall not employ.any person in such manner as to become-subject to_WorkMan's-.Compensation laws..of-California. Signed ---------------------- --- ------- -•- --------- Owner -title --- r --------------- - --------- --------------- f of r han owner) FQ1 DEPARTMENT USE ONLY APPLICATION ACCE TED BY --- --11-1�__ DATE 7.1z ---------------------------- ----------------- BUILDING PERMIT ISSUED ------- - - ---- -- --- ---------------------------------- ---DATE ------- ADDITIONALCOMMENTS ---- '- -- -- --------------------------------------------- -----------------------=-------- ---- - -------------------------- - ----------------------------------------------------------------------------------------------------�-- ---------- + ---------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------ - ---------------------------- -- - ----------- Final Inspection by: - Date _ �. SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M - f.