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FOR OFFICE USE: A 1 L 1��, ,e,�► c,c --•......................... APPLICATION #OR SANITATION PERM! F � ......I�. _. Permit No: .��"-1�-�..... 4, (Complete in Triplicate) ......................................... This Permit Expires 1 Year From Date Issued Date issued, -�6 i 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/LOCATi6l\l . ......_.-__X__...._,..................f ....._.__..... CENSUS TRACT ........... ...... a Owner's Name �� cam....... i'?e ..w —........•--•---•..............•--............_...:.:.,............._.._._Phone ........ ........................ Address City .... ....................... ..--•• -• � -----•...............•.._...._....- . -•••••-......_•••••...__..... Contractor's Name License :: Phone ... S9` i E Installation will serve: Residence ❑ Apartment House❑ Commercial ❑Trailer Court 0 Motel 0 Other ---------._--............. --•••--••--•• Number of living.units:....•:_..__. Number of bedrooms ------------Garbage Grinder ------------- Lot Size ............................................ Water Supply: Public System and name ..---•----•••--•----•-••=-•---•................•-----•-----------•-•------------------------------------•- -•--Private ❑ Character of soil to a depthM of 3 feet. Sand ❑ ._Silt❑- Clay ❑ Peat❑ Sandy Loam . Clay.Loam ❑ 11! 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 ori reverse side.}' i NEW INSTALLATION: {No septic tank or seepage pit perm ifpublic ewer is available within 200 feet,), r W5 / PACKAGE TREATMENT SEPTIC TANK-[ j (— Size.......---------------------------------------•-- Liquid Depth .......................... S Capacity .................... Type ------��-------- aterial-------- ............. No. Compartments ...................... Distance 4o nearest: Well -----•-------•-••-__• ------•-__-•--Foundation ...-- -- - Prop. tine. ..r.... �J� LEACHING LINE No. of lines _,____________________ Length of each line----�(�----._......... Total Length Rte._._...-:_.....:4 . _ 'D' Box Type Filter Material ...Depth Filter Material ---•------- Distance ------•-: :-- ... �i D stance to nearest: Well �. _.l _ . - � ... Faunda#ion • Pro a Line r.- =- SEEPAGE PIT [ j Depth .....:................. Diameter ----.........:.. Number............................. Rock-Filled =Yes-to.. ,.No C3 Water Table Depth ..-Rock Size Distance to nearest: Well -------------------•....................Foundation --.................. Prop. Line ....................... REPAIR/ADDITION(Prev. Sanitation Permit# J ................. .................... pate .................................. i Septic Tank (Specify Requirements) --------------•--•------ -------.............. ---• ....... . ..................--.-............. •• ...... Requirements) ------- Disposal Field (Specify' ' ' ---------,-•--••----•------------- f G--- - rr•-------• . .. -- •--••. ----------------------------- ----------------------------------------------- - ---- ---- I (Draw existing and required addition on reverse side) l I hereby certify that l haY� 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 "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." w L Signed --=------------ --•-•--•....... Owner r_ .....•.................. (If other than`owner) j 4 FqfDEPARTMENT LIS ONLY APPLICATION ACCEPTED BY ..... --- -- -- ---------- --- •---•-•---••--•-••-••••-•--•-_. DATE .''.J r . .............. BUILDING PERMIT ISSUED!1:........ ? ..................... :.......DATE .....----••.......................... ADDITIONAL COMMENTS l.......----•--- ......•-•••................. .... ..,.. .. ••. ... .- .-- Final inspection by. .... ... .. Date ,..7 ............ SAN JOAQUIN -LO l HEALTH DISTRICT t E. H.J-3 24 1.'68 Rev. 5M I 7/72 3-M