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FOR OFFICE USE:__ �" APPLICA-TION•=fOR-5-ANITAT-ION-?ERMIiT— Permit No. -.O/----------. (Complete in Triplicate) ldl -------- ------------------- ---------------------- Date Issued This Permit Exp ires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is made in compliant ,with County Ordinance No. 549 and existing Rules and Regulations. JOB ADDRESS/LOCATION -+ ��.__ CENSUS TRACT --------------•-----•----- --- ----- -- ---- ----- -- ------- -- - Owner's Name ------ ._ a i Phone `' '` Address ----- --•-.. City --- -- ------------------- ---------------------------------------- C, ------------------------------ ---- ---- -- ---- Contractor's Name -� <' _---License Phone ------- ------ ------ - ----------- 1 Installation will serve: Residen ❑Apcirtment House❑ Commercial ;❑Trailer Court l❑ Motel ❑Other____ -------- Number of Diving units------------- Number of bedrooms ------------Garbage Grinder ------------ Lot Size -------------------------------------------- Water Supply: Public System and name ---------------------------------•---------------------------------- •--------- ----- Private I Character"of soil to a depth of 3 feet: Sand'[] Silt❑ Clay ❑ Peat El Sandy Loam Clay Loam ❑ f [ i 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,) PACKAGE TREATMENT [ ] SEPTIC TANK'[ �] Size-..- %`�-----x-�-I-- �'---- --- .-- Liquid Depth ---` --------------.-----� Capacity _dDU_. "-i�ypeejA (4,- '--- Material--- / ._--- No. Compartments ----.---•.----40 (' -- -- i i Distance to nearest: Well ---------- ------------------Foundation -------- 0.---- -- Prop. Line ---------- -----� f ` ' _ Total Lengthy � r LEACHING LINE [�I; No. of Lines ------------------------ Length of each line__.._.-_ it 'D' Box ------------ Type Filter Nldterial __.......R-,--_Depth Filter Material ---- - --------- __-_.----_..-.--- . '--- - - ' l ----------- Property Line Distance to,nea;est: Well --- , off _=p__FNumberon.----- -I==_- ---------- •Rock Filled Yes '�No 070 SEEPAGE PIT [l� Depth -------- ---- Diameter -_ w a Water Table Depth sQ -------•--------------------Rock Size ------ / 1 Distance to nearest: Well -------------1- d-e--------------Foundation --------- Prop. Line 51 (Prev. Sanitation Permit# -------------------------------------------- Date ------------ ---_•-.------_-_-) + { SepticTank (Specify Requirements) -------- - --------------------------------------------------------------:-------- ----- ---------------- ----------------------- ----- Disposal Field (Specify Requirements) ------------------------------------------------------- =" r,.i -------------------------------------------------------------------------------- J +. -------------------------------------------------------- t(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 become subject to Workman's ompensati.on laws of California." Signed ------------------------------------------ ---- --------- --------- --- - ------------ Owner g `------------------------ ------------------------ Y --------- -------------------------------------- --- --- ------ ' -Title - (If other than owner) f FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -------------------------------------------------------- DATE ��---7 ---'--------------- BUILDING PERMIT ISSUED --------------------- - - ---------- -------------------------------------DATE ------------------------------------------- - ----------------- ADDITIONALCOMMENTS ------------- ------- --------- --------------------------------------------------- --------------------------- -------------- ------------------------------------------------ -- ----- -- ------ --- ------- ��7r ,� - Final Inspection by: -------------------------------.Date -------------------------------- '4 SAN JOAQUIN LOCAL HEALTH DISTRICT i E. H. 9 1-'68 Rev. 5M,