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FOR OFFICE USE; 'a w. z ( APPLICATI.OW—FOR SANITATION PERMIT T �r t -(Com lite in Triplicate) Permit No. ._._-_.----�_"-•-•� P P ----------- -------------- -------------------- This Permit Expires 1 Year From Date Issued Date Issued ._S`_,V:�t_jc,t`-Id,� Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. This application is madeincompliance with County Ordinance No. 549 and existing Rules and Regulations: k JOB ADDRESS/LOCATION ---- ----�<,-.-----�--- �_Q -- - ------------ - ---------CENSUS TRACT --- � Owner's Name !/ ------------------------------- -------------------- _Phone ------------------------------------ - -------------- Address a.f77_ ------ --- -------------------------------- City ------ _ I Contractor's Name ...... -" --- ------ �p��s r License # �� , Phone Installation will serve: Residence XApartment House❑ Commercial ❑Trailer Court ;0 t Motel ❑Other l Number of living units:..___.__ Number of-bedrooms ______Garbage Grinder lYe-- Lot Size �________ { Water Supply: Public System and name _______________________ _ ---------------------------------------------------------------------------------- - Privatet Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam. i Hardpan ❑ Adobe ❑ Fill 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.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) v } PACKAGE TREATMENT [ SEPTIC TANK i ° Size__ �-�-1®---------------y---�----- Liquid Depth _A Capacityl�Qi7____ Type - Materialeoll��,oAo. Compartments X Distance to nearest: 'Wellr ��p-------- - ----------Foundation _XV------------ Prop. Line��;........... LEACHING LINE No. of Lines ° ----:-____-- Lengthof each line---- "---- Total Length 'D' Box ._�!9 Type Filter Material/_A499; Depth Filter Material `F-n------._ Distance to nearest: Well -------- Foundation /Q..........._-%Property Line ___�1 SEEPAGE PIT Depth _. _________ Diameter _.. Number —Number _ _- Rock Filled Yes.X No C ' Water Table Depth -----fr�1 ---------------------------------Rock SizeI _ -�-3 F�------- I s /I a'" leDistance toj earest: Well __ f ------------------------Foundation __41740.rt-------- Prop. Line .-%.f.............. REPAIR/ADDITION(Prev. Sanitation,Permit# ------------------------------------ ------:Date ---------------------------- -_-) Septic Tank (Specify Requirements) -----------------------------------------------=�"�_--------------- --- ! Disposal Field (Specify Requirements ) ------------------- -------r r --------------------------------------------------------- ------------------- 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: "I certify that in the performance of the work for which this permit is issued,!l shall not employ any person in such manner as to become subject to Workman's'Compensation laws of California,"-f l � t Signed ---_-- -- - ------------- w r n Y r (If othe than owner) .a lR .# FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY /"� --� f _.---- DATE�-7-1" --- " BUILDING PERMIT ISSUED ----------------[-_--------_-- -- / fDATEy ADDITIONAL COMMENTS --------------- -I - ------ f -- ------------- ---------------- ----------------- --------------------------------------------------------------- ------------------------------------------------ ------------`---------------------- -- ------------------------- - i --- . •- _ __ -------------------- -- t ` -------------- ----- t ` ----------- Final Inspection by: -- _ - —'' Date . .r_ ----- " -------- ------ ------ ------- - �»� �LL- SAN JOAQUIN LOCAL HEALTH DISTRICT 1 "10 s E. H. 9 1-'66 Rev. 5M