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FOR OFFICE USE: APPLICQ`1I®N' OR SANITATION PERMIT'- " ` - ----- _- (Complete in Triplicate) ---- ---------- - s Permit No. - -------------------------------- - This Permit Expires 1 Year From Date- Date Issued Application is hereby made to the San Joaquin Local Health District for a described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: permit to construct and instal! the work herein JOB ADDRESS/LOCATION .-_ ------- "__ g s• -------------- -----------------------------------------------•------ ----- ------- Owner's Name - "-_ l=am CENSUS TRACT Address �{ / Phone --- - - ----- Contractor's Name ". City C� -------------------------------- tL -��--------- ---- ------------License # - ----- -:--- ----------- Residence installation will serve: Phone ---� ❑Apartment House Commercial :❑Trailer Court ,E] Motel EJ OtherC_. O / Number of living units:-----/---- Number of bedrooms - ----Garbage Grinder Lot Sze "l _-��5 Water Supply; Public System and name - --------------------- Character of soil to a depth of 3 feet: Sand' it -"la ---- "--------- --------------------------------------------------- -- y " ---- ----------- -- - _ Private-® ❑ Silt[] Clay ❑ Peat� Sandy Loam Clay Loam ,o Hardpan , P ❑ 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,} PACKAGE: TREATMENT [ I SEPTIC TANK [ ] Size ��c5` Capacity�0� 6 1- �--- ---- Liquid Depth - ----- Type�-�"----- ----- -- Material _ ' o. Compartments -"2----- 00 Distance to nearest; Well _-____ LEACHING CINE � --------------------Foundation - ----------- Pro Line �� 00 [ ] No. of Lines p -------=- -"_--- - ---�-- ---------- Length of each -------------- Tota! Length C7 D' Box ---/------- Type Filter Materiale,L� /i ----------------- /,5; Depth Filter Material ________ n Distance to nearest: Well ----G -_ !> ----_"`""---'---- ----- Foundation -----_"- -- -------- Property Line SEEPAGE PIT p ty ` Diameter 1 Depth --- - -- -- ---------- ---- ----------- Number ----- --------------------- Rock Filled Yes ❑ No [3 Water Table .Depth ---------_ -_-------Rock Size -----------------""- ------- - Distance to nearest; Well -""-------------------------------------Foundation --------------------- Pro Line _-"-----____--__- REPAIR/ADDITION(Prev. Sanitation Permit# __-----__------------- f - ----- ----- --- Date ----•--•---- Septic Tank [Specify Requirements) } Disposal Field (Specify Requirements) ------------------------------------------ --------- ------------------------ - -- _ (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 Dis#riot. Home owner or liven- . sed agents signature certifies the following: "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 --. - Owner lTitle - ------------------ (!f other than owner FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY "_." ____ BUILDING PERMIT ISSUED -------------- _ ----------------------- DATE ----3_-- ADDITIONAL COMMENTS DATE ----------- - - -------------------------------------------------------------------------------- ---------------------------------------------------------- ----------------------------------------- .- _ E Fina! Inspection b --- -------------- -------------------------------- --- ------------------------------------ ------------ --------------- Y- ------------------------------- -------•------ ----- --- - - ------ -------Date ".,�C'� --�: -- - -- -- -=•- ---- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M