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` FOR OFFICE USE: 11 APPLICATION.FOR 5.ANITATION PERMIT (Complete in Triplicate) Permit No. . Z�_-7P.___. ___-___ This Permit Expires ] Year From Date Issued Dafie Issued -_---_'3'7L 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/LOCA,_�/�l TTIIO,N/�3---- -------vs.------- :!/, � � ------ ---------- - CENSUS TRACT j Owner's Name -ei` = f -------- ---- ---------------Phone ----------------------------•- Address ----------------- ------------------------------------------ ------------------------------------------ City Contractor's Name ----------------------------------------License #1&_lc.rR0�---- Phone Installation will serve: Residence 'Apartment House,F] Commercial ❑Trailer Court i❑ Motel ❑Other Number of living units:-----/_--- Number of bedrooms _,,__Garbage Grinder ------------ Lot Size --------,lG _______________ Water Supply: Public System and,name ---------------------- -;------------------------ ----------•--------•---------------------------------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe Lk, 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 SEPTIC y TANK Size_____ l •��1----�q�-)-r��---�-9 ------ Liquid Depth ------ --�----------- Capacity _./' D�___ Type _ �___ __ Material(�h.4�__ No. Compartments _ _. Distance to nearest: Well _________�__Q__�____-__-_-__Foundation --------,___!_ Prop. Line No, of Lines ------ LEACHING LINE Ids -----�-------- - Length of each line---- -�----�.��___-- Total Length -----/�Zll._'-____-- Ir_De th Filter /r 'D' Box Type Filter Material -------------- p er Material ____________/ _______________•-_--___- Distance to nearest: Well --------Foundation------- �______ Property Line ---- SEEPAGE SEEPAGE PIT Depth ___� Diameter / ��- Number __-___-__-_-�_---____-__ Rock Filled Yes 2f No i❑ Water Table DepthJ�-_� Rock Size --------a-- -------------- ------------- Distance to nearest: Well -----�•9-ew___f_________ __,--•-Foundation ___�Q-_______ Prop. Line __/V____________ REPAIR/ADDITION(Prev. Sanitation Permit# -------_------------------------------------ Date ___________________________-____-_) SepticTank (Specify Requirements) ------------------- ---------i----------------------------------------------------------------------------------------------------- ---------- Disposal Field (Specify Requirements) --------------------------•-•--•-I------------ ------ -- ---------------------------------------------------------------------------- --------------------------------- ------------------------------------------- -------------------------------------------------------- ------------------------------------------I------------------------ ----------------------------------- ------------ ---------------------------------------------------------------w--------------------------------------------------------------------------------------- (Draw -------------------------------------- - - (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 Son Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: _ w "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 ------- ---- ---71----------------------------------------------------- Owner BY - - - ---------- -- - ------ Title ------ ------------------ (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --- ------ -- -------------------------------------- DATE - 71a' ---- BUILDING PERMIT 155UED ------ --------------------- :-------DATE ADDITIONAL COMMENTS ------------------------------- -------------- - --------------------------------- --- - } --------------4 Final Inspection by: �'-"4 --- ---------------- ---- ---------------------------- ----- --- ---- -----•-- -Date ------ '4zzem SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M C.T�