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FOR OFFICE USE: _,A.PPI (CATION FOR SANITATION PERMIT a 7s (Complete in Triplicate) Permit No: "___________ --------- ----------------------------------------------- ________________-- -- ---- This Permit Expires 1 Year'From Date Issued Date Issued 7. Application'is'hereby'ma de 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 exist'n Rules and Regulations: (2-, - 0_(11 ,2 y JOB ADDRESS/LOCA ION . -----�------------------------------------------CENSUS TRACT J--1 _ ----------- Owner's Name �"��` -------------------------------------------- Phone Address--------------------- --------------------- -------------------------------------------------- City--------------------------------------------------------------_---------------•-- Contractor's Name_ _______ _ F3� ._.License # Phone _�I✓18 �?� -------------- ------ Installation will'serve: Residence OApartment House❑ Commercial :❑Trailer Court i❑ ^ r Motel ❑ Other ------------ ------------------------------- Number of living units:______-___ Number of bedrooms - ----- Garbage'Grinder /i/0 Lot SizeAWL __._--___________ Water Supply: Public System and name ------------------------------------ --------------- I ------------------------------------------------------- Private X Character of soil to a depth of 3 feet: Sand'❑ Silt ❑ Clay ❑ Peat Sandy Loam (] Clay Loam ;❑ Hardpan ❑ Adobe ❑ Fill Material ------------ If yes, type ___________________________ ( (PI'ot plan, showing size of lot, location of system in relatiori'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,) (O PACKAGE TREATMENT { ] SEPTIC TANK Size__ X_ _ _ 2_. ----------- Liquid Depth 4 -_ Capacity IQ� Type_!_ Material-/?[_.__ No. Compartments ___L-______._..__ Distance to nearest: ------ Well Prop. Line _77!777____.__..__ ;r LEACHING LINE [ ] No. of Lines - ------------ --- ----- Length of each -------- -line ----------------------------- Length- x�- �-----_---------.. . -I'D' Box J0 Type Filter Material1epth Filter! Material-l---�"""�'----- - . v } Distance]to iresst: Well _ � 5Q Foundation �� _I- - Property Line, __:____._______________" SEEPAGE PIT'.[ ] bepth Y_ 0_ k meter ____________ ___ Ntmrber ___dam_____- ---------- Rock Filled des No ❑ Water Table Depth --�5 / -------Rock Size -- --Z �2-t------------ Distance to nearest: Well----------------------------------------Foundation-------------------- Prop. Line a-_-----------•-•_--.-• REPAIR./ADDITION (Prev. Sanitation Permit #--------------------------------------------- Date ---------------------------------- Ih Septic Tank {Specify Requirements) - ---- ----- --- ------------------------------------------------------------------------------------:-------------------------- - Disposal Field (Specify Requirements)----------------------------------------------------------------------------------------------------- ------------•---------- ----- ---- -------- -- -- ----------- (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. Horne owner or licen- 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- - -------------------------------------------1------------.'Ow -------- --- - - a. T .'Own&r IN ----------------- - itle T- l----- ---- ----------- ---- ------------------------------------- (If other t owner) Ir If APPLICATION ACCEPTED BY._ BUILDING PERMIT ISSUED ------ .__ A DITION L M ENTS Final Inspection by: jb- "-�� -1I--- E. H. 9 1-'68 Rev. 5M, USE ONLY ------------------ ----------------------------- DATE .KK1 :?6 ------------------- ------- -------- ------ DATE -------- -------------------------------- is A-� 60 -JO-------------- + -------- ----------------- O ------._ -------------- _ ----.Date -fls ------ SA JOAQUIN LOCAL HEALTHESTRICT