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FOR OFFICE USE: I 4 yA ICATION FOR SANITATION PERMIT Permit No. - �_-.60.7 [Complete in Triplicate] - -------•-- "------ ---- ------------------------ ______________________.___.____-_ _-.________,___ This Permit Expires 1 Year From Date Issued Date Issued _l=._�'._7v 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 compli nce with-County Ordinance No. 549 and existing Rules and Regulations: `lj OC ti� JOB ADDRESS%LOCATION" ----=------------"-- = ---------CENSUS TRACT -------------- ----------- Owner's me --------Phone AddressI -------j- - `S City ._ _ --------------------------•-------------------------- Contractor's Name � °--- -------.License #P S_- �7 -__ Phone Installation will serve: Residence ❑ Apartment Ho) use❑ Corci Mote! [ thef�❑Trai ❑ ler Court Number of living units------------- Number of bedrooms ------------Garbage Grinder ------------ Lot Size ------ --------------------- Z Water Supply: Public System and name ---------------------------------------- ---------------------=- ---------------------------Private,' Character of soil to a depth of 3 feet: Sand'❑ Silt El Clay El Peat❑ Sandy Loam Clay Loom ❑ �o 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,) 4f PACKAGE TREATMENT [ I SEPTIC TANK Size_ y `�� S`/1C/� Liquid Depth _. r _ - ----- Capacity 360.4_ Type �� Mateial_.0 ____ No. Compartments -__ _____________ Distance to nearest: Well -------------------Foundation ----P.7-Ll---------- Prop. Line LEACHING LINE No. of Lines - -_t .�____ __t_ Length of each line_,/d_Q---_--------- Total Length ----�_� ______---__ D' Box _________-_ Type,Filter Material _��1_1�0_l+bepth Filter Material _._!__�________________ ________�__- 711- Distance to nearest: Well _ __.________� Foundation ___ ____________________ Property Line .15_____._----;�---- SEEPAGE PIT Depth _. __*f Diameter �_ _______ Number4---------r_��_________,____ Rock Filled Yes ' No i❑ L� j .. . . 1 .� Water Table Depth --------=C-Q- -_ -------------- --Rock Size - -- - -------------- E y� ,. 1 / ']y� Distance to nearest: Well .1'00_ ______ __________________Foundation __.w?.�!_,-_-- Prop. Line _'____.N'!%�!±!-, REPAIR/ADDITION{Prev. Sanitation Permit;.# _-_________________________________________ Date _____________.____-______--..-_.-� Septic Tank (Specify Requirements) ---------- - ------------------------------------------ ----------------- ':-__,.. Disposal Field (Specify Requirements) ------------------------------------------------- ---" 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 San Joaquin t 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: r- - "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 bec a su ject tp W 'kman s Compensati.e.nn,.laws of California." Signed --- ---- ------- ---- -- Owner BY --------- -- --- - 9C, ' -------------------- Title ------- ------------------------------------------------ (if other t an owner) I t OR . EPARTME E ONLY APPLICATION ACCEPTED BY -- _-�-- --- .-- I DATE _.. -- .L_.7a.__•------------------- (01- 1 BUILDING ---- BUILDING PERMIT ISSUED - ---- ------- ------------------ -------------------DATE --------------------- ------ ADDITIONAL COMMENTS -------------------- ` = -------------------------------------------------------- a --------------------------- -------------------- --------------- ------- --- --------------"--------------------------------------------- ------------ ------------------ -------- -------------------------------- ----- Final Inspection by: - ,. - -------- ----------.Date - --- -. --------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'6B Rev. 5M