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FOR OFFICE USE: AppLICAYIOK AOR SANITATION PERMIT ------------------ -------------------------------------- (Complete in Triplicate) Permit No. _____________________________.___:_ _________ This Permit Expires Y Year From Date Issued Date 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 --------0 -1/-- - d_Q- ------------------------------CENSUS TRACT -----------'/------ Owner's Name -------------�/7 Kv ^�----------L- Phone 7 rfQ�Y T city � C --------------------------- Contractor's Name --------Qwl�kIF—�----------- -----.License # ---------- ------------- Phone --------------------------- Installation will serve: Residence ❑Apartment House❑ Commercial ❑Trailer-Evwt- Motel ❑Other -------------------------------------------- Number ------------- ---------------------- ---- Number of living units:v__/__--_: Number of bedrooms _--Garbage Grinder---- Lot Size _ACRC_A4_ -ice_____-____- Water Supply: Public System and name ------------------------------------ __________________________________________________________Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat Q/ Sandy Loam E] Clay Loam P---'Hardpan EDAdobe ❑ Fill Material Jff1,l.__ 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 seeps pit permitted if u lic sewer is available within 200 feet,) 1' PACKAGE TREATMENT [ ] SEPTIiC.TANK'[77 Size--- --. -.--x_-�O_.-x-.-�_____._ Liquid Depth _Y__ --------------- Capacity _1_ -Q__ Type ME-M-5 Material__ NC �`o. Compartments -'- ----------------co istance to nearest: Well -------1�___�'^f--------Foundation /, ....__________ Prop. Line __ ._" ^S LEACHING LINE Na. of Lines __ �_____ Length of each line__ Q__r___________ Total Length ____� ..._-_..____ D' Box�� Type Filter Material _S0_&t pepth Filter Material ___! '_�_4_____________-__ Distance to nearest: Well _ a__�^ = Foundation _____10-7y----_ Property Line ____ _____________ SEEPAGE PIT [ ] Depth ____________________ Diameter ______________ . Number _____._-____-___________ Rock Filed Yes F) No 0 00 Water Table Depth _----------------------------------------------Rock Size ------------------------•------- �+ Distance to nearest: Well ----------------------------------------_Foundation -------------------- Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------) p Septic Tank (Specify Requirements) -----------------------------------------------------------------------------------------------------•----.,.___._----------------•--•-- 9' 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 District. Home owner or licen- sed agents signature certifies the following: "I certify. 'n the perform ce of the work for which this permit is issued, I shall not employ any person in such manner as to bec subj t to Wo n's Compensation laws of CaliFornia." Signed ------- ------- Owner BY -- ---' --------t-:----------------------------' ------ Title ----------------- .._ - ---------------------------------------------------- t (If,other than owner) -j Aut FOR DEPARTMENT USE ONLY &OWPI Jli'�^d JCe►RC C, APPLICATION ACCEPTED BY ------fr( - r ---------------------------------------------------------------------------- DATE --- ------ BUILDING PERMIT ISSUED ----------- -------------------------- -------DATE -------------------- --------- - - - --- ADDITIONALCOMMENTS ------------- -- -------------------------------- --- -------------------------------------------------------------------------- -------- -- -------- - - ----------------- ------ -- --- - -------------------------------------------------------------------------------------------------- ----------------------------------- ---------- -------------------- ---- ---- -------------------------------------------------------------------------------------- ------- ------------------ -------------- ---- ------ -- ---- --- -- -- ------ ---------------------------------------------- ------- Final Inspecti '----------------------------- ---Date SAN JOAQUIN LOCAL WEALTH DISTRICT E. H. 9 1-'68 Rev. 5M