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FOR OFFICE USE: ft�A PIIAAe ANITATION PERMIT (Complete in Triplicate) Date Issued _"_..-.__________________..__ ----------------------- This Permit Expires 1 Year From Date Issued , 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 Ordinance No. 549 and existing Rules and Regulations: JOB.ADDRESS/LOCATION/.---.s_---S-� ----------= A------- _00--f4------1. CENSUS TRACT - Owner's Name Gti/�l/ J� '-.-..------ �1.0 {a - e�j ' -------------- 6 Address _3 ;-.�,._. . --- "Phone.s; -- ----- �.. .... . . . = � �-_= -: City J �� * ----- - ------ - Contractor's Name __-� ¢ f d e"--License# ------------------------ Phone -------•---------------------- Installation will serve: Residence ['�partment House❑ Commercial ❑Trailer Court ❑ - Motel ❑ Other __.__ --------- --------------------------- Number of living units:----- --__ Number of Brooms _____Garbage Grinder _ft---q5 Lot Size _"- ........... F Water Supply: Public System and name ---- •'-------------------------------------------------------------------------------------Private ❑ Character of soil to a depth of 3 feet Sand [] Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam Hardpan ❑ Adobe *IFill 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.) vc W NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) r PACKAGE TREATMENT SEPTIC TANK'[ ] Size__+!>✓_ __,¢'_,4�`�__�_9_____________ Liquid Depth ______ __,r Capacity Material---------------------- No. Compartments -----. ............ Distance to nearest: Well _______________"_______________Foundation -----_a_--________ Prop. Line ...._ ..:........ 11 LEACHING LINE ( J No. of Lines ________/______ _-__-_ Length of each line_-".----l--0--- Total Length .__.__ ............ � �r 'D' Box _ o.,--- Type Filter Material i__ q epth Filter Material -------/,9__`l_________ _______________ mffc Jr'2ti .� � / Distance to ne�rest: Well :��g�_____ Foundation ____1b_________.__ Property Line _____; /� ___________ SEEPAGE PIT [ ) Depth ____ _ _________ Diameter _---...... Number --------- ---/------------- Rock Filled Yes Z3-1 No IQ -`' Water Table Depth _____--_6_0-_l-____-__-- .Rock Size -_'._�_~ `r # Foundation _._- ._Q ------- Pro �........ c.- Distance to nearest: Well ---- 4{2_-------------- ---- p. Line ...._, y REPAIR/ADDITION(Prev. Sanitation Permit# _-___-_-__-(-_______"k_"________-"_-__.____ Date _=l_-______________________) SepticTank (Specify Requirements) --------------------------------------------"----- ------------------- -,-------• ------------------•---------,..--------------------------- Disposal Field (Specify Requirements)—t'—_"-O" ) -- ------------------------ - ------------------------------------------------------------------------------------------------------------------------------------------------ r-I -_-..___"---------- -------_-----.:---,-_--_----_--_--______.___-__._-_____________.___________________.._____w_____-___---_----________________.___________________________-__-_____-_---__-_"_--_________ I }(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, arid Rules and Regulations of the San Joaquin Local Health District. Nome owner or licen- sed agents signature certifies the following: I f "I certify thc+t,inathe performance of'the work for which this permit is issued, I shall not employ any person in such manner as to become%su 'n t to Workm 's Compensation ws of California." Sigh s r ------- Title- - 0e r ' --- Ti t (If other than owner) i 1 DEPARTMENT USE SONLY 3 APPLICATION ACCEPTED BY" ----------------•-- -------------------7---- DATE -r- BUILDING PERMIT ISSUED DATE -------------•------•---------------------- ADDITIONAL-COMMENTS ---------------=------------------ -- ------------------------------------------------------------------=` -------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- t _ - - ----/1' �--L----/---'---------�----s-�---------------------------------------------------------------------- -----------------------------------_-------------------- ----------------------- Final Inspection -- -------.Date �� R__ - by SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M. r