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FOR OFFICE USE: APPLICATION: IFOR:,.SANITATION PERMIT ----------------------- ----- (Complete in Triplicate) Permit No. �- ----------I------- -------------------------------------- ---------------------------------------------------------- This Permit Expires i Year From Date Issued � Date Issued "------ - -- f Application is hereby made to the San Joaquin Local Health,District forz,ier,'permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules an Regulations: 1 JOB ADDRESS/LOC TION-I r--LJ��/ ,------ - --- ' ------1 --- �rJ - _-G�MeEA US TRACT -------------- ----_- Owner's Name ------ ------f-7a- r �1l__l`-d------------------------------------------------- ----------- ---- --Phone------------------------------------- Address -----Address 2 ��.� City - -- --------------------------------- ..............----------------- - - _ ' r. Contractor's Name .. _.. -- -f------- ------------------ Phone D----:- License #�C Installation will serve: -- Residence" partment House-❑ Commercials:❑Trailer Court ❑ Motel ❑ Other -------------------------------------------- ti 1 Number of living units:________ Number of bedrooms __-- _Garbage Grinder, _ ___._.__ Lot Size ______ a Water Supply: Public System and name --------------------------------•--------------------------- ----------------= ---------------------Private ••Character of soil to a depth of 3 feet: Sand'❑ Silt❑ CI y ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe Fill Material If yes, type - I� (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 ublic sewer is available within 200 feet,( PACKAGE TREATMENT SEPTIC TANK, ze___ i C -/� .1,�_ ---------- Liquid Depth ,� ------------- ; Capacity Type _ _ Material______` _ �cGh- o. Compartments - .........._. Distance to nearest: Well --------- -----------------------Foundation _.__ ---------- Prop. Line . " r LEACHING LINE [ No. of Lines _-_�-------------- Length of each line_.__f--� ------------ Total LR th ,a..- .. ...._._. 'D' Box Llo �°<s__ Type Filter Material p �t yp __!\-[1CY�----Depfili� Filter Material --"-- ------------------........ •___-- Distance nearest: Well ___,_`�___{_________ Foundation . _ " ___"________ Property Line -' --___"""._ ...... SEEPAGE PIT � Depth --------- Diameter __�'________ Number _______ _______________ Rock Filled Yes No i❑ Water Table Depth..----y=f =/ I-------------------------.--..Rock Size 11 = .. --"--- i (� 1 Distance to nearest: Well _._____!___________-----------------_...Foundation 1Q_, _______ --- Prop. Line .._... ....... REPAIR/ADDITION{Prey. Sanitation Permit# -" --------___ ------------------- Date ----------------------------------- Septic ________________________________ ) p f � ' Se tic Tank (Specify Requirements) -_ - P { P Y q 1 `. = ` � r — - � Disposal Field (Specify Requirements) ---------- --------=--------------------------------------------------------------------- _ _--- [Draw ex and re uired ad e ! � , g q add on reverse side) I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin F 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: ;- �- —•-- -- —, _ _ w __, "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 Compensati.onllaws of California." Signed ---- ------- ------- i Owner 'U Title BY �r ✓ 1 � -- (if other than ow er - FOR DEPARTMENT USE ONLY l qQ APPLICATION ACCEPTED BY ------ ---------------------- --------------------- DATE _40 72--_-------------------- F :BUILDING PERMIT ISSUED --------------------------------------------- - 3 --------------------------------------DATE ------------------------------------------- ADDITIONALCOMMENTS ------------------------------------- ---------------------------------------------- --------------- -------------------------------------------_--------• -• ------------------------------------------------------------ --- --------------- --------------------f---------------------------------------------------------------------------------------------------- -------------3--------------------- --_--- ��-- - � -------------------:- Final Inspection b -- --------- - ----------------------- Date _ __'---- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M