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I C' FOR OFFICE USE: 3 �''S i S � �cjtltoN APPLICATION OR SAN ATION PERMITS� -� � Permit No: -------------- ----------------------------------------- . 1Complete in Triplicate] P Date Issued 6 This Permit Expires 1 Year From Date Issued Application is hereby mad to the San Joaquin Local Health District for a permit to construct and install the work herein described. This a licatio is made in com lian�e w� C Ordina a No. 549 and existing Rules and Regu! tions: i pp � � � 9� �'` �i �f�� JOB ADDRE55/LOCATI N7Q-S�. -L/�f --- ----(--�'D-__�� ./,-_-- _CE S ACT ----------------- ------- Owner's Name Q_ --�D -- Phone" r // � ----_.------------------------------------`City / l Address 1 � - ----------- -----------------•-- ContractorQ Name ---------- Phone ------------------License # , Installation will serve: Res}dente KAparlment House❑ Commercial :❑Trailer Court ',❑ 1 v . Motel F1 Other -------------- --- `---------------------- < ��nsX-L Number of living units:._._/--_-_ Number of bedrooms -'�[__-`Garbage Grinder � Lot Size -------------- ' ----------- Water Supply: Public System and name ----------------------- --- -- ---------- Private ❑ - Character of soil to a depth of 3 feet: Sand'] Silt 0. Clay ❑r Peat❑ Sandy�Loam,-y Clay Loam ❑ - f Hardpan 0 Adobe:� Fill Material ------------ If yes,type 1i-------------------------- (PI'ot 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 permi ed if public sewer is available with En 240 feet,) ,V_w1� t / � PACKAGE TREATMENT [`� SEPTIC TANK Size-� __� S__----p- ------------------- Liquid Depth ---'i�-------------..----- k Capacity -fUE-_--- Type Material-L---- / No. Compartments ------- --------- 'A to nearest: Well -------- - �'-----------------Foundation -.lvf_-_�--_---- Prop. Line -_S-_-_.�---------- ----------- Lent of each line--.-------- _---- -- ---��Total Length LEACHING LINE � No. of Lines -.--__f- 9� �/�- g Q' Box /�)_--- Type Filter Material -_-��- CDepth Filter Material __�_ _------------------____...___ Distance to nearest: Well __37-0- --__.__---_ Foundation .f_0-------------- Property Line __----__._---_.-..._ f ri � SEEPAGE PIT Depth ___ _ ---- -- Diameter ----- Number -_------------------`-----ock Filed Yes;® No ❑\^ t V(9- REPAIR Rock Size _--_l ,X---,�_ -- Water Table Depth --- --------------- ---- - __' -- � F I K:-_- _Foundation l d_-------- Prop. Line . Distance to nearest: Well ____- - - .= . DDITION(Prev. Sanitation 1Permit# -------- ----------- ---- Date ---------------------------------- /A ) t Septic Tank (Specify Requirement) ---------- -A 4 ------------------------------------------------------------<_--------------- ------ ? Disposal Field (Specify Requirements) --------- ----------- ----------, �'„------ --------------------------------------------- ---------------------- ---•----------- ..------------------------------ i - ------------- � ' -------------- =--------- --------- �, j. -- -------------- ---------------------------------- ---------- ------------------------ .(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 Son 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 subjectto Wor n's� tion law California." Signed --------------------- ------------- Owner ------------------ Title ------------------------------------------------------------------------ (lf other than owner) ,. FOR .DEPARTMENT USE ONLY APPLICATION A Y - ------ -- DAT .7 - --70 ------ ------------ BUILDIN 1T ISSUED ------------ -- ----- - ---- ------------------------------------ ADNAL ENTS ----------- ------------------- --- ,5 - --------=----------------- --------- i ------------------------------------- -------- ----------E-- �if F al Inspection b ---- --.Date ----- ----------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M. I