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FOR OFFICE USE: ! APPLICATION ICOR SANITATION PERMIT ,. (Complete in Triplicate) Permit --------------------------------------------- This Permit Expires ] Year From Date Issued Date Issued _.�_�_"_� : 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 Or inance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION -� CENSUS TRACT ' �r Owner's Name _.� �i4/? --------o �-- -- --Yom€ :_____------ �] - ------------ --------- --- - --------------Phone --------- -------------- - Address ..__✓ Qs�. �9 ----- ---------- City._ Contractor's Name _____, .Q-�� cy� �" • _ - y -.- --License # .ler,5Zt .____ Phone _140 _ f07 Installation will-serve:— - Residence Apartment House,6 Commercial ❑Trailer Court ❑ Motel-❑.Other ----------- :: Number of living units:___ ___ _ Number of. bedrooms -�_: _Garba_ge Grinder ------------ Lot Size -- - -- - - ----------- ----------- Public System and name Water Supply: __'_ _ _____ ----------------------Private ❑ Character of soil to aJdepth of 3 feet:� Sand;U L-,-Silt((] Clay ❑ Peat E] Sandy Loam -E] Clay Loam 'EJ Hardpdn-EJ, . '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,) V PACKAGE TREATMENT [ ] SEPTIC TANK'[ 7 Size------------------------------------------------ Liquid Depth -----------------------••- Q Capacity ------------=--" TYPe —_"=-`-"- --�"Material----�-- ------- No.No. Compartments Distance to nearest: Well -- ----------- -Foundation' --_----------------- Prop.Lin -------------------{s LEACHING LINE [ ] No. of Lines ------ ------- Length of each line----------------- ___ Total Lengtht f � 'D' Box .----------- Type Filter Materidlo-':--_- -------Depth Filter Material --------------------------------------- 7a ----------- --- -- ---- ---------- ---- - Distance to nearest: Well ----------___----------�'Fou'ndation ------------------------ Property Line SEEPAGE PIT - [ ] Depth _._____-_-____-'-- Diameter ---------------- Number ----- ---------------- -- Rock Filled Yes No i[:] Water Table Depth ------------------------------------------ ----Rock Size Distance to nearest: Wel! ----------------------------------------Foundation -------------------- Prop. Line -------_--_--------- REPAIR/ADDITION(Prev. Sanitation Permit# --------_----------------------------------- Date ___-__---_--___-___-_--______-_.-.) Septic Tank (Specify Requirements) ----x��0__� s ----= y Disposal Field (Specify Requirements) _ _ _ _- ---------------- -------------------------------------------------------------------------------------=------------ ----- ---- - - - ------------------------------------------------------------------- (Draw.existing and-required addition on reverse side)4 _ 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 ficin- 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 become subject to Workman's Compensation laws of California." Signed Owner - - - ----------------------------------------- BY -- - ------------------ -- ------------ Title ---------------- -------------------------------------- (lf other than owner) � FOR DEPARTMENT USE ONLY C APPLICATION ACCEPTED BY -----C?_--4------- , DATE s �� BUILDING PERMIT ISSUED ---- ------ -------------- -----------------DATE --------------- - ------•- NAL COMMENTS ____________________ ___ ------- ---------------- ------------ --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------- ------------------------------------------------------------------------------- ------------- inal Inspection by. - -- -_ ------------------------------ --------- -- ----�--F ___-- -- ---- - - --------------- -Date F Date --------------- ----- -=--- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev, 5M