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FOR OFFICE USE- 9., SE•9.•j_ APP!.°: idN FOR SANITATION PERMIT / /; �^ ...----- •----•-------------- Permit No. _k__7-_!/ 7J� (Complete in Triplicate)` ---- ...............„ ,,,,,_-,,,, .,„_,-„ ,,-,,,,, I This Permit Expires 1 Year From Date Issued Date Issued/_(_- 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 Ordin nce No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION - - -----k1 TRACT --------------_---•-_-- Owner's NameV ---------------- ---------------------Phone4_�7'� X3--------- Address ------------------ - City - - -- -- -- - Contractor's Name -----_ -,- - : ` ' �# _ --------- --#--- -----License # --------- Phone Installation will serve: ResidenceApartment House❑ Commercial []Trailer Court i❑ Motel-p Other ____7g19!_1ER__----4M.i4_ Number of living units:-----l---- Number of bedrooms ._._ Garbage Grinder ------------ Lot Size ------ ---- _____ ............... Water Supply: Public System and name .._----_---------- ---------_---------------------------------------------- -----------------------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Gay ❑ Peat❑ Sandy Loam ❑ Clay Loam;❑ Hardpan ❑ Adobe Fill Material ----- ------ If yes,type ____________________________ p� (Plot plan, showing size of lot, location of system in relAon to wells, buildings, etc. must be placed on reverse side.( O NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT { ] SEPTIC TANK, Size_-------�--X7__-'7-_--_,_-_--__- Liquid Depth ....... Capacity /,Y1Pl!_1� ► Type Material___ C.------- lila. Compartments ....._.... Distance to nearest: Well ______ _____________Foundation ---l--d__--------- Prop. Line ...........0......... LEACHING LINE [ ] No. of Lines ---------J------------ Length of each ppline-_---_5 d----__-_____ Total Length 9.d_......._.__ 'D' Box ------------ Type Filter Material _ —Z L:_=:_Depth Filter Material -____,1, ............................. Distance to nearest: Well -------_�-S_4---------- Foundation ------/- ----------- Property Line .......... ............. SEEPAGE PIT [ ] Depth ----;L' �� __ Rock Filled Yes ' No - -_-____-- Diameter _!-$......... Number --------____l_ ________-- 0 Water Table Depth Rock Size ---/---------------- � r l Distance to nearest: Well ----------- _w-------------------Foundation -----16 Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ______________________ --------------------- Date --------------lk ------------- Septic Tank (Specify Requirements) •------------------------------------------------------------------- Disposal Field (Specify Requirements) ------------------------------------------------------------------+-�`-t ' -------------------------------------------------------- ------------------------------------ =--------------------------------------------------------------------------------- ---------------- -------------------- ---------------------•--------- -------- -------- -- ---- -------- ----- ------- ------ -------- -------- ------------- •---------------------- --------------------------•---- (Draw existing and required addition on reve i;e-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 that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California.” Signed --------------------------------- ---------- --------------------------------------------- Owner 1115� BY -r----- -- ---------------------------- Title --------- ��=:'----------- ------------------------------ (If other t owner) FOR PARTMENT USE ONLY APPLICATION ACCEPTED BY------- _ 2`2--�� - - _ DATE 1 - -- BUILDINGPERMIT ISSUED ---------------------------------------=---•--- ---•-------------------------=------- -----DATE -------------•---- -------------- ----•---- ADDITIONALCOMMENTS ---------------------------------------------------- -------------------------------------------------------------- -------------------------------------- --------------------------------------- - ----•-----------------------------------------------------------------------------•-------------------- --------------------------- ------------------------- ---------------------------------------- -- --------------- --- ------------------ ------------------------------------------------------------------------------------------------------------- ---------------------------------- ---- ------------- --- ------------------------------------------ ------------------------------------------------------ -A ------------------------------------------ -------- - / -- -=------- FinalInspection by: ------- ---------- ----- -----------------------------------------------------------------------------------------Date --/ ----- ---- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.