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FOR OFFICE USE: APPLICATPERMIT ION,FOR SANITATION ° ------ ---------------- Permit No. {Complete in Triplicate} - -------------------------------------------------------- -----------------------------------------_--------------- This Permit Expires 1 Year From Date Issued 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/L ION _ - -----Z-- ----- --8+-f, CENSUS TRACT Owner's Name 1 ---- ---- - ----Phone2/•�_" 12Y7.. `.� _?y Address _. � '-�., City-- Contractor's Name _� �.`!� _ -- -- _-_c c— License # _ YiZ, ___ Phone 1cG_` Z1 z -------------------- Installation will serve: Residence'' Apartment House'❑ Commercial [-]Trailer Court '❑ W e Motel ❑Other ------------------------------ r � Number of living units:-'__ ____-___ Number of bed oms _____OZ_Garbage Grinder ------------ tot Size -____ , Water Supply: Public System and name - [t! ---------------------------------------------------------- ---------Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt[❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ u Hardpan ❑ Adobe>e Fill Material ------------ If yes, type ____________________________ 4 (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) L�4 NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) �r ` PACKAGE TREATMENT { ] SEPTIC TANK'[ ] Size------------------------------------------------ Liquid Depth -------------------------- i IP Capacity _______________________'Capacity -------------------- Type -------------------- Material--------------F----- - No. Compartments ;Distance to nearest: Well ------------------------------------ Foundation ---------------------- Prop. Line __--__...___________ LEACHING LINE [ ] No. of Lines ------------------------ Length of each line---------------------------- Total Length _________--___________...__ 'D' Box ------------ Type Filter Material --------------------Depth Filter Material -------------------------- Distance ------------------------Distance to nearest: Well ________________________ Foundation ------.----------------- Property Line. --___ __.________-_--_- SEEPAGE PITDe th [ 1 p Diameter ________________ Number ----------- ---------------- Rock Filled Yes ] No i❑ Water Table Depth ------------------------------------ -----------Rock Size -------------------------------- `E Distance to nearest: Well ----------------------------------------Foundation --------------- Prop. Line ....................... r REPAIR./ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ---------------------_------------) Septic Tank (Specify Requirements) ------------------- ` f Disposal Field pecify Requirements) ---- - ---------- -- n ------------------------------------ ------------- -------------------------------------------------------------------- ------------- - (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 bec su jgct tp rkm 's Compensa ion laws of California." Signed ------- Owner ------- -- --------- ---- --- - a BY - --- ---- Title -------- -------- -------------------------------- - ----------- (If other than owner) { FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- ---- - 5 ----- --N-407-7 --------------------------------------- DATE --I ~'l -------- BUILDING PERMIT ISSUED --DATE ------------------------------------------- ADDITIONALCOMMENTS =--------------------------------------------------------------r' ------------------------------- ------------ --------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------�` ------- -- ---------- ------------------- Final Inspection by: ----7----- ----- --� -7�- -- ------------------- - ------- --- - - -------,Date --- --------- - SAN J AQU1N LOCAL HEALTH DISTRICT V E. H. 9 1='68 Rev. 5M