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FOR OFFICE USE: � APPLIC TIOWFOR SANITATION PERMIT �' Permit No. "------ ----------- (Complete in Triplicate) y Date Issued _.__7-------------- 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 hereir, described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: CENSUS TRACT --------------•-------•--- JOB ADDRESS/LOCATON .---- ----------- ---------- ---- -----Phone 7 7-- --------- ---- F - - -- --- ---------- - -------�--`--------- Owner's Name - ------ ----------- City __-- Address c 6# ----.Liense� ." h & T bra"C�7_. one Contractor's Installation will serve: ResidenceC4Apartment House❑ Commercial ❑Trailer Court ',❑ Motel ❑Other,------- - �'---Garbo ---------------- Number of living units:_.- "--___ Number of bedrooms -___ ge Grinder _- LofiSze � - � r ' ------Private Water Supply: Public System and name ----------------------------- ------------------------ -----•--- ------------- ---------------- r' f Character of soil to a depth of 3 feet: Sand'❑ 'Silt❑ Clay �❑ Peat❑ Sandy Loam Clay Loam .E] Hardpan E]`—Ado'be'❑ -Fill Material ------------ If yes.typ6�--------------------- (Piot 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,) ., SEPTIC TANK� J Size-' -x�a---------------------------- Liquid Depth _.. ` PACKAGE TREATMENT { ] ---------------- t , __ Material ' '----- No. Compartments ._ -------- Capacity ".90-- 6'�---- Type 'w f i Distance to nearest: Well "" -�""°'-�0-� _ Foundation ___�- ------------- Prop. Line ___.____.-f--____.. ----- --- -:_a- �-Length of each line.-----7-0------- ------ Total Length -------- LEACHING LINE No. of Lines "- „ 'D' Box ___` " Type Filter Materia ----Depth Filter Material ----le--------- •----------------------- '-0 ' Foundation --- �--r t -------- Property Line --- -------------------- Distance to nearest: Well -___�� ; ;_ SEEPAGE PIT [ ] Depth ---------- --- ----- Diameter ----i Number ------------------------ Rock Filled Yes ❑ No I❑ Water Table Depth -------------- ! =------------Rock Size ------------------------------•- _.,.._ -.� -.F..._ Distance to nearest: Well ------------------------------•----- Foundation --------------------- Prop. Line ------------.--------- REPAIR/ADDITION(Prev. Sanitation Permit# --------------`----------------------------- Date ---------------------------------"1 r Septic Tank {Specify Requirements -------------------- --:-----------•---------------------------------- I Disposal Field (Specify Requirements) ------------------- ,. _ . ti * -----------------------•------------ ------------------ -'--------- j �-------- ---- - - "--- ---- {Draw existing and required addition on reverse side) I hereby certify that I have prepared this aOplication 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 Compensation laws of California."� I Signed -- -- ---------- Owner r Title ----- '-- -------------------- By - - _ -------------------------- (If of a than owner) OR DEPARTMENT USE ONLY :. DAT �" 2 ` ------- APPLICATION ACCEPTED Bx—s / ==- ---- ------- BUILDING PERMIT ISSUED --- � -- - -------- ----------- DATE -------- -------- ------------ - MNTS -------------- ADDITIONAL COM a- ------------------------------------------- ------------ --------------------------- -- ----- ------7 - ----------------------------------------------------- ------------------------------------------- ----- --- --- ----------------------------------------------------------------- P y• ,' Date ----- `` ----------- - Final Inspection b �--------- ' ---- ----------------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M