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FOR OFFICE USE: FOR OFFICE US`.��' R� ,� -APPLICATIONJOR SANITATION PERMIT //�� ---- Permit No.t 1 -1 . 'z (Complete in Triplicate) --------- This Permit Expires ! Year From Date Issued 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 - ---------- ------------------ --- --CENSUS TRACT ---- --- ----------- /Owner's Name { ' j-- -// f - - .-_------l--- Phone Address -' ----- -- -- ----- ------------ _ _ Contractor's Name -------- - -_______. -_e--------------------------------License # :-J-- _y_ hone Instaflation'wili-server -Res idence-]Apartment-House-,❑-Commercial-i�Trailer-Court-, - Motel ❑ Other -------------------------------------------- Number -----------------------------------Number of living units:------ .__-,Number_of. rooms _Garbage Grinder__ Lot-Size _,/ ill.- __" .______-__--- Water Supply: Public System and name .._-- �--L�- --L- -------- - --------------------- -Private ❑ Character of soil to a depth of 3 feet: ,Sand'❑ Silt❑ Clay-O. Peat❑ Sandy Loam ❑ Clay Loam:❑ Hardpan ❑ AdobE ®` Fill Materia! - ®!f yes, type ____________________________ (Plot plan, showind'siie -of iotp,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_._ _ { ] L �s� � ---- Liquid Depth � -----. Capacity - `�_O_ __ Type - t _ Material __ _________ o. Compartments _ .________------------- Distance to nearest: Well ------ ----- ---------------Foundation _______ Prop. Line-_!51�____ LEACHING LINE No. of Lines _________ ___________ Length of each line_______®__ ._____ Total Length ,___ --- 'D' Box -itl_ __ Type Filter Material _.J% --------- Filter Material /e-_--f____________________________ Distance to nearest: Well __'f-__________ Foundation ______ -Property Line _-t5-71--------- SEEPAGE PIT E4/� Depth s:__ -____ Diameter,__?_j/__ Number _____,�._.________i_=_:_�! ::Rock'Filled Yes g��No i❑ �1 Water Table Depth _____-6_! J __ � -----------------------=--------Rock Size -- --�-�-��--'--------- Distance to nearest: Well __________________Foundation _.�' ------- Prop. Lina - /----.__ REPAIR/ADDITION(Prev. Sanitation Permit# ________________ R } ------------------ -�-- ,-=-- Date ---�_----------------_:___ SepticTank (Specify Requirements) -------------------------------------------------------------------------------------------------------------I—-------------- ---------_-- Disposal f=ield (Specify Requirements) -------------- - } ----•------------------------------------------------------------------------------------- ---------f----- ----------------------------------------------------------- ----------------=-------------------------I--------------------------------------------------------- ---------------------------------- (Draw.exisfing 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. Horne owner or licen- sed agents signature certifies the following:- "I ollowing:"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." Signed � -- -------. --------------- -_ -------------- "Owne BY ------------- ---------- --- ---- '------ -- Title6 - (If othe wned � DEPARTMENT USE ONLY APPLICATION ACCEPTED BYf---- ' - ----------------------------------------------- DATE ---- .�...r-}�. ------------- BUILDING PERMIT ISSUED -- DATE ------------ ---------------------------'; 1. ---------------------- -------------------------------------- ADQIT(ONAf COM ------ -------------------------------------------------------- r pp i- -------------- f-=--------------------------- ' t�� n ----6V->--e-------- a_k d-------a -7 I w�i<tS-t b� f --- - �-�-----•--- -----------------ft.o ff'.. fo Q a¢ u 6e� s -- -------- ------- - -- ------------------------------------------- _ FinalInspection by: -------- = - --------------------------------------------------- --------------------------Date ------ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H.`9 1-'68 Rev. 5M,. �. k .N�`