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FOR OFFICE USE. APPLICATION FOR '5ANITA`I•ION PERMIT ................ 1Complete in Triplicate) Permit No. .. :.....•`..S- ; .................... This Permit Expires 1i Year From Date Issued Date Issued . :o . 75 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 .. _ . .. ---- "f..... ---- .... ..... TRACT _... Owner's Name .......... _ .. .. .. .. .- . .-. ._. .. -S--�._.....6..._.....Phone-••--••--•• Address ~ City Contractor's Nome ------ ---- �._____ License3 _.... Phone ..�._. ..__. i o ..----- Installation will serve: Residence ❑Apartment House❑ Commercial ❑Trailer Court ❑ ,AAotel ❑Other -------- ................... ` I /p Number of living units:.. Number of bedrooms ._3__...Garboge Grinder ._.......... Lot Size ..�3®.__.)c,/ I� Water Supply; Public System and name __........ ••----• ---- -•_ _.._..._..Private ., i "'"'Cha octe►oof soil to a depth�of 3 feet: 5anr1❑' -Silt p Clay��"peat p Sandy loam ] tr Gay Lo m❑ 1�'" Hardpan Adobe b< Fill Material ........ Ef 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,) PACKAGE TREATMENT SEPTIC TANK f J Size.__.------------..------------------------------- Liquid Depth Capacity .. . ........ ...... Type --- ...... Material..---- - No: Compartments -_.._._.,_Distance to nearest: Well .-.-•---------- Foundotion _.•...............:... Prop. Line _._..:.. ........ , ,arest: LEACHING LINE [ j No. of Lines _. .---- Length of each line.... _ Total length { D' Box Ype_Filter,,Materiall �... e �. _ ........... Di tance,to nearest: Well ..............•-•- -•-- Founds ion ..-------------•.---..-. Propetrty.;hne --.-----..._:......_.:.. SEEPAGE PIT "t`�`�` t, � [ J Depth ... . ----. DiameTter—....,:`. ..:` Number -Rock Filled Yes ❑ No I] �Waatte-Table Depth .............. . Rock'Sizry e Distance nearest: Well .------- ----.- ---Foundation, ..................... Prop. Line .._..._.. ........... REPAIR/ADDITION(Prev. Sanitation Permit# ........ ........ .-I Date +_ -------- Septic Tank JSpecify Requirements) Disposal Field (Specify Requirements) 4 ...................... ........ .......}_..- .......... .. \\\••. ...111 �.1. _...".............. •lY@.tib I.. S ._..._... ----- ....-- .......... �V ---- ---------= -------------- (Draw existing and req uired addition on reverse-s'idel� _ I j 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 Sanl,l quin Local Health District, Homeowner or lhett- sed agents signature certifies the following, '� „_t t "I certify that in the performance of the work for which this permit is issued, I shall not et; to c P y y personinsuch manner as to become subject to Workman's Compensationt1"' i of California." Signed .... . ...... . ....)- ----------- ........ Owner O) . . ----------- Title .._.._ .`-..... ' {E je - By owner) # FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY .._ .,.__. . BUILDING PERMIT ISSUED ......._............... ..._-----... DATE .-..... .. Y 7S ........ ...... ... � ...- �. DATE ...-----.-- �-----...---- -..._. ADDITIONAL COMMENTS ....../� d ._ __ ,.._zr-. --- ---- ----- -- ------- .. -...._._ -------------- ----------------------------- •--------------- ...................... ....-- ---- - ..... ::::---:::::::::::::::::: _ , �. ........... .......... Final Inspection by: ---- ...._ Q ....... a te . .:• :. _ SAN JOAQUIN LOCAL HEALTH-DIST H..13 24.1='68 Rev. 51V1