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FOR OFFICE USE: I APPLICATION FOR S ----7 "' t ,!_ ANITATION PERMIT PermitNa: 1-- --- -------- --------------- x 6 �7U (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. - mak-----,- . t�' ----------- -------- ------ --------- - CENSUS`TRACT -------------------------- Owner's Name ._ ;y O - - Phone �%��c''Lr <f/ / - ne -------------------------------- --------•--• Ci#Y ~� � ------------------------------------/ Address -_. �1 / :. ---- Contractor's Name �1� -` � �= L9cense # l7h5_47J__ Phone - J - __ 4""-t - __ �� Installation will serve: Residence T1 Apartment House F-1Commercia1 :[]Trailer Court !,❑ ' " f I Motel []Other ---- ---`------------------------------------ V ---- -------- --------- ------ � ---------------- Number of living units:--- ___ Number of bedrooms _t.0-`-. "-Garbage Grinder /_--C?--- Lot Size ________ _____ ---_____ I Peat Sandy Loam -----------------------Private ❑ Water Supply: Public System and name ---------------------------------- ------ --- -----'-----`------------ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay '❑ ❑ ❑ Clay Loam ❑ Hardpan ❑ Adobeo< Fill Material ------------ If yes,type ------------------------- I (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------------------------------------------------ Liquid Depth ---------------- --------- {� . . No. Compartm.ents - Type -------------------- Material------------------Capacity ------------ Lin e ---------- Distance to nearest: Well ------------------------------------Foundation ------ Prop (1n LEACHING LINE [ ] No. of Lines -- --------------------- Length of .each line---------------------------- Total Length D 'D' Box --------- - Type Fitter Material ---------------------Depth Filter Materia ---------- ----------------------- i ------ Foundation --- Property Line. -------------------=---- Distance to nearest: Well _________________ ------- --------- - SEEPAGE PIT [ ] Depth -------- ----- Diameter - Number ------ Rock Filled Yes ❑ No f -----Rock Size -------------------------------- 0 ------------- r Water Table Depth ____-_-_ -.- - -"----- I ` Foundation Prop. Line --------------- Distance to nearest: Well _____________________________ REPA1RcA aDlop(PteSanitation aa ,n,I Permit# -------- ----------------------------------- Date -------------------l-�•---------�--�--y- $ep k v Requ rements) ---- --------- ------ --------- ------- - ) - I - ---- - ------'- ---------------------------------------------------- -�--- ---------- Disposal Field (Specify Requirements) fix•- -7,5--- -e------3_3------------------ -- ------3.3------------------ -------------------------------- --------------- ------------------------------------------------------------- --------- 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, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: "! 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 Workm n's Compensation laws of California." -------- - -------------- ------------- Owner Signed ------------� �! ��T�-`----- - - ITitle --- ------------------ ------------------ ------------------------------ --- - " ""-- Y --------------- -- " - (if ot-h-er--than n-owne'rf I FOR DEPA1tTMENT USE ONLY -� � ------------------------------------------------ DATE -_. --`--''��-�---1---�-�-------- APPLICATION ACCEPTED BY r- ------ ------ — ----- DATE BUILDING PERMIT ISSUED -------------------------------------- - -_ -------------- ------ - ADDITIONALCOMMENTS -------------- ------------ ---- --- ----- --- ----•----- ---------------------------------; i ------------ ---- ----- ----------------- ---------- ----------------------- ------- -------------------------------------------------------------------------------- ------------------- -------------------------------------- Date -;2 ------------------------------------------------------------------ ----- Final Inspection b N JOAQUIN LOCAL HEALTH DISTRICT I E. H. 9 1-'68 Rev. 5M. t