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FOR OFFICE USE: TSANITATION PERMIT FOR OR SA r — : Permit No. .7......-- ................... (Complete in Triplicate) ._................... Date Issued ..............::... ........... This Permit Expires 1 Year From 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 Ordinance Na. 549 and existing Rules and Regulations: JOB ADDRE55/LOCATION �� ----' ` : .....CENSUS TRACT ..................... . . � Owner's Name .. .._ t►U. ..... y _�.. lZ ,._..._. CITY. .' Address - ...................................... License # .J�' .:. Phone`s_. -... Contractor's Name .. - ............. T ' Installation will serve: Residencet"Apartment House Commercial [-]Trailer Court Motel ❑Other..:.°...:........... Number of living units:.,.. ,._._. Number of bedrooms ..._ ....... Grinder ..............Lot Size .._..... ......� ............ Water Supply:.Public System and name r.._-._..._:------------- -.-.#:-•------•---- -----------------:...Private [ ` Character` of soil to a depth of 3 feet: -Sand❑ Silt❑ Cla ❑, , Peat❑ 5andy Loam ❑ Clay Loam:0. i Hardpan.❑ Adobe Fill Material If yes,type .- 7. (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 civoilable:within 200 feet,); [ � - �. PACKAGE TREATMENT SEPTIC TANK Size:-- ��. �1°_.a�...... ..;.�f.:. ..., Liquid Depth ........°.. Capacity .J. P d.a ..7.4Type �r nal k-� ; No: Compartments _ .._....... rf Mate Distance to nearest: Well :, .-, ``'-- --•---'-_--_Foundation' -...1. -. --- Prap. line --- .-- _ No. of Lines Length of each line .--.,.-��. ._�.--- Total Length .. 00 LEACHING LINE [l� j g 'D' Box ._-.- - Type Filter. Mciteri'l -� _!_'..Depth' Filter Material ............:........... ..... . j ._. :.... . 1. 'Distance-to nearest: Wel 1 ::..... � -:- Foundation ;.JE7. `:.-.._ Property Line . .. O } SEEPAGE PIT [14 Depth , Z. :/ - Diameter :..:: -_-- :" Number - :--- -- ------ --- Rock Filled Yes [ .fNo ] Water Table. Depth. -:..-_-•- :..Rock Size .-. a_ ...:. Prop Line -- 'S ..........Distance to nearest: Well .......... - Foundation. t. REPAIR/ADDITION(Prey. Sanitation Permit# ------- ,: --- ---- Date ---- ---------- 'Septic --- - --'Septic Tank (Specify Requiremenfs) '_..;__.-.- _, ..:............. . ... .......................,.__.. -.. Disposal Field (Specify -Requirements) ------------------------------------':---------- ............. ._.............._......__....----------- --------- .. --- ....... ........ ----- -• ................................... .. ... ................. ...... ....... ............. . .. ........... -.:....._•--..._.. _;..__._._._ ...------....__...................................... ........-.._...._......_._._._......__. (Drdw 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 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 i -. --- . �-� � ... __-- T'itle -- _. ._.-... B (If other than owner) Y - - ' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY 7rC ----------- ^.---__._. DATE + BUILDING PERMIT ISSUED ...... ... , .... _-DATE ......._...._...-------.._.._...._..._..._. ADDITIONAL COMMENTS ----------------- -----------_ .. -------- ....... •----.... .................. ........ -- � _.ww .._:_ .. . .... ....• .......__. .... .. . . . ------ , ...... . - .. ....... ................. ......' ._ _.._. Final inspection by: .....__..._ _ .. J .._ .. :............ Date ... .�. ., SAN JOAQUIN LOC L HEALTH DISTRICT f o t u 13 24,_ an Qnv 5M 7/723,