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FOR OFFICE USE: APPLICATION"FOR`3AN1TATION_PERMIT_ _ -,��S ., ._...�... ,- --•�-«.-f- Permit No. - - -'-- ------ ------------------------- --------------- I (Complete in Triplicate) - ------ Date Issued ?` This Permit Expires 1 Year From Date Issued v - - - --------------- 7----------- ---------- 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 --- - -------°---------------CENSUS TRACT = -/---------- ------------ ----- --------" --�.±�'1---� - LLPhone------------------------------------- Owner's Name -----(3', ----------------------------------•------------ CitriO�----------- ----------------------- Address ---------- ----- - ----- =8 ,1 sox------------------------ Contractor's Y Contractor's Name l License #g .%$. -E!' Phone -- Installation will serve: Residence �arfimenfi House❑ Commercial ❑Trailer Court ',F] Motel ❑Other --------------------- ---- --6=----------- Number of living units------------- Number of bedrooms ------------Garbage Grinder ------------ Lot Size -------------------------------------------- � — - Private E]Water Supply: Public System and name -____a__ ------ � Peat " Sand Loom Clay Loam 0 Character of soil to a depth of 3 feet: Sand' Silt❑ "Clay ❑ ❑ Y ❑ 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 seepage pit permitted if public sewer is available within 200 feet,) r �- Size-------------------------------------- - Liquid Depth ___-------------•-------- PACKAGE TREATMENT [ ] SEPTICTANKq� � . °Capacity ----------------f=-°Type -------------------- Material No. Compartments -- - k; ; } Distance to nearest:—Well ----- - - ---- ------------------- -Foundation ____"-- Prop. Line ---------- t � t LEACHING LINE ,[ ] No, of Lines ----------------- ---- ______ _____ �_ ,-: Length of each line---------------------------- Total Length __--___------------•---•---- -- -- _Depth Filter Material -------------------- 'D' B ------------ Type Filter Material ----- --------- - - Foundation ----------- Property Distance to nearest: Well______ Line. ------------------------ r SEEPAGE PIT [ ] Depth ---i --_ Diameter __ ------ Number ---------------------------- Rock Filled Yes ❑ Na 0 s Water Table Depth Rock Size ------------------------------ - Distance to nearest: Well ----------------------------------------- Foundation ------ Prop. Line ---------------------- REPAIR/ADDITION(Prev. Sanitation Permit# ........ � g o. Date ----------------•---••------------) Septic Tank (Specify Requirements) --- .`---------- ------------------------ ---------------•- Disposal Field (Specify Requirel eats). ---------/, � .... ' ----------- a t + f _ _ _ fi -„---------------"___-_--_---"___--------___.-"._-_--____-----_--_ S _ _ ------------------""-- .� ,. 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 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 becom o rk n's Compensation laws of California." Signed :' caner .-,. G a ----------. Title --- --------- - - ---------------- ----- ----------- --------- ------ (if other than owner) f OR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - -- -- ---------------------------------------- -------------- -- DATE ---�-""��--�- -rf-+�---- ------ BUILDING PERMIT ISSUED ----------5--- --------- - - --- ----------- -------- ------------- -------DATE ------------------------------------------------ ADDITIONAL ------------------------------------ - ADDITIONAL COMMENTS --------------------------------------------------------------------------- ---=-------------------------------------- ----- ------------------------------- ------------------------------------------- ---------------- ------------------------------------------------------------------ - -------------------------------------------=------------------------------------- � l _ -- - ----------------------------------------- ------.Date --- ------ ----=------- Final Inspection by: ------------------- -------------------- - ------- SAN JOAQUIN LOCAL HEALTH DISTRICT F- H_ 9 1-'68 Rev. 5M :-