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FOR OFFICE USE: LATIwN F qR SANITATION PERMIT ----------------------------------------------------- (Comp Permit No: . r. lete in Triplicate) F------------------------------------------- ----------- --------------------------------------------- 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 desc-r.5bed.-Thisppplication,is.made in compliance with County Ordinance No. 549 and existing Rules and Regulations: v� JOB ADDRESS/LOCv4TION j __- -�- ------- -_t's ;s__�-1- --/--.`�"'` 2+ 1- '-- - r-- CENSUS TRACT ----------- ------- } Owner's Name ------- --A K Vv-,-{--�------`-W,- ---------.------------- := =-----------Phone --------------------------------- Address ---------------t- r ------ 1 t 4 City --[ Contractor's Name ___"_� __. � S`_._ 1_ __ _______:_______-License'# - 5 Phone __ .. r_ �� t✓ Installation will serve: Residence Apartment House-❑-Commercials❑Trailer Court i❑ Motel ❑Other -----------------------------------------•'---- r Number of living units:_--_____ __ Number of bedrooms --,_____Garbage Grinder t _ _____ Lot-Size _:�.�3__ _ _ __________________ •-r. Water Supply: Public tystem and name __ �_''_ ...___ Private ❑ � - 1 Character of soil to a depth of 3 feet: , Sand ❑ Silt❑ Cl�Yillmatereial`,OtA&--- PSandy Loam -❑ Clay Loam:❑ Harc pan.❑ Adobe'❑ 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,) I PACKAGE TREATMENT [ ] SEPTIC,TA�NK y Size---_�X^rx-.T�t.----_--------_-- ---w Liquid Depth --w— 2_---------.----; N I CapacityType - - Matenalo. Compartments +: stance to nearest: -----------Well ____________________Foundation _.1 Prop. Line __� _. ...:........ LEACHING LINE No. of Lines ___.��—________________ Length of each line._ff—j Total Length 12 l ' —'D'.-Box -I, __- Type Filter Material Qe-- _------Depth•Filter Material -19-111----------- 'Distance o nearest: Well ----- 4.f_________ Foundation ----- __L__,________ Property Line + [ p r � - Number ------. J ' Rock Fi�d Yes ,1..No SEf�C7[-T<T D`e pth �_U Diameter `�- f--}--nrr Water Table Dep ---- �t' =----------------------Rock Size 12—X-3--------------- C / / -�•s Distance.to nearest: Well ______•�"_f__________________________Foundation ____l___.�_�__________ Prop. Line _._.- ---_.___._ - REPAIR/ADDITION(Prev. Sanitation Permit# ------------------------------------------- Date ----------------------------.-----) { SepticTank (Specify Requirements) ----------------------------------------------------------------------------------------------------------------. ----------------•---------- Disposal Field (Specify Requirements) ------------------------------------------------------------------------------------------------------------------------------------* ----------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------�-----------. ------------ f �.. (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 r 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 "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 -------------------------------------- -t-- Owner a ---- ----------------------------------------- --------- t BY `' { ;-X Title -------------- '' '(If o he .than owner) s ' OR DEP RTMENT US Y APPLICATION ACCEPTED B ...L BUILDING PERMIT ISSUED ---- -------------------------- - _DATE ------------------------------------------ ADDITIONAL COMMENTS --------------------------- - - -------------=-----------------------=--------•-- ---- •-------- r ----------------------------------------------------------------------------------------- -- - - - �------------------------------ - -- ------------- ----- -- -- ---- ---------------------------------------------------------------------- --- -- - Final Inspection by ----------- - -- - - - ---- ---------- ------------- - ----- ------------Date --� �-�--��-- --- --. A SAN JOAQUIN LOCAL HEALTH DISTRICT r E. H. 9 1-'68 Rev. 5M