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FOR OFFICE USE: APPLICATION FOIL SANITATION PERMIT Permit No: - �7. y ------------------- } (Complete in Triplicate) 12/ ��OLt�/�f ------------------------� ° 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: ,t r� - ' ----------------- ---- -`- ------CENSUS TRACT �i-�-�---_------�--�- JOB ADDRESS/LOCATION ------- ' - � f Owner's Name -------- -------� -------------------- -------- - ---- .44 I - -----Phone - !E- i Address _ City �-�� Contractor's Name f .. '�Iriz"-,`a 'a License # --� rl L3 I Phone W "�C 'c- Installation will serve: Residence ❑ Apartment House❑ Commercial :❑Trailer Court Motel ❑Other ------------------------------------------- Number of living units:-J-4)--- Number of bedrooms ------------Garbage Grinder ._.-_--__-" Lot Size _-- ____ ________ _ __ _ __ I .Private, ] Water Supply: Public System and!name -----------------------------------__ _ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe'EX Fill Material ------------ If yes, type ---------------------------- k (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) r NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 240 feet,) PACKAGE TREATMENT [ ] ' [ ] Liquid Depth -------------------------- SEPTIC TANK Size----------------------------------- --- --- Ca acit _ Type -------------------- Material---------------------- No. Compartments ---_.-.-------...-- Distance }to nearest: Well ------------------------------------Foundation ---------------- Prop. Line ---- 11 ___ Total Length Box rues - 'DD'' J Length of each line LEACHING LINE [ ] o LType Filter Material --------------------Depth Filter Material ----------------------------.---------------- `"t -____._- --__ Property Line Distance to nearest: WellFoundation el SEEPAGE PIT [Vr/ Depth _,_� �---- Diameter `---- Number ----_--- -f ----------- - Rock Filled Yes No Water Table Depth ----------- --- -------Rock Size ------�- ------ �a rl D5tance {o.-nearest,:-Well ----_-- -- ----------------Foundation ---- ---- Prop. Line __ ------- -•------ \� REPAIR./ ITIO [Prev. Sanitation Permit# -•--------- Septic Tank (Specify Requirements) --------------- ----- --------------------------------------- i [ . -- z Disposal Field (Specify Requirements) ___ _ __ __ � I ____�- ^ _____________1. 1_a-_________--____-___._----____.____- ------------------- - ----------------- --------------------------------------- - -------------------------------- ------1----- --------------- --------------------------------=--------------------------------------------------------------------------------------------- (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: "1 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 _____________ Owner B ' �� -------- Title Y (If other than owner[ FOR DEPARTMENT USE ONLY Q APPLICATION ACCEPTED 6Y ' --------------------------------------------------DATE -----U.'C' -�'t--1-- ------------- BUILDING PERMIT ISSUED ---- -------- DATE ------------------------------------------- ADDITIONALCOMMENTS ----------------------------------------------------- ---------•--------------------------------------------------- n ------------------- --------------------------------- -------- -------------------------------- ---- - - ---- " Final Inspection b Date --"-"------ --- =- ---- ---------------------------------------------------------------------------------------------- - - -------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. SM `v