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FOR OFFICE USE: - ,. f +3 ti -APPLICATION ICOR SANITATION PERMIT ............ ..........................:. `:_- Permit No. .7.5 W {Complete in Triplicate) i, Date Issued ........................................................................•._.................._..........._ _This Permits xpires,t Year from Dot*lss.ned� _�... . Application is herebmade to the San Joaquin local Health District for a permit to construct and install the work herein described. Thisapplication is made in compliance::with County Ordinance No. 549 and existing Rules and Regulations: ' JOB ADDRESS/LOCATIO ...........CENSUS TRACT ... N .. � �. . ...._._. .......... ....................... Owne s+Name .._...... . ...L ,......_.............:........ .......Phone Address b I City ... _ . Contractor's Name ---••------. ..G __.4 5 i.icense 4,7`r �7 �.... _ Phone � ...�� 7... ..._ Installation will serve: Residence 0Apartment House Commercial OTra#ler Court 0 i Motel ❑Other....... . ................. .. '• ... r �� JNumber of living units:_.__..... Number of bedrooms -_.Garbage Gr€n�der _. ...... Lot Size ..... --__.._x_. ........:... Water Supply: Public System and nnrrsw`�"""""'' i 4� ...............Private Q Character of soil to a depth of 3 feet Sand 0 Silt Q Clay�QPeat❑ Sandy Loam El Clay loam Q f - !N, Hardpanj Adobe FIH Nldterial ...._._.. ._ If yea,type ...7.......... ............ I V, I I ! i (Plot plan, showing size of lot, location of system in i lat#on 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,) i PACKAGE TREATMENT j ] SEPTIC TANK I ] Size........................... ..................... Liquid Depth ...................... Capacity Compartments ....TYpe . 5 Distance to nearest: Well ------------------------------------Foundation Prop. Line ......................6 LEACHING LINE [ ] No. of Lines ------------------•---.. Length of each line.-----f---._...._......__.. Total Length ....._.....................X I f 'D' Box ......_......Type Filter Material ....................Depth .FilterxMaterial .............._......_.....................� +. _ Distance to nearest: Wel ......... .............. Foundation ....... Property Line ............... SEEPAGE PIT [ ] Depth .... ............... Diameter �.--------•--_-- Number -r_.- \--:....-= .. Rock Filled Yes ❑ No Cj Water Table Depth W ......_•--- .......F:........Rock Size* '"...... { Distance to nearest: Well -----------------------•_.....-_........Foundation ........_........... Prop. Line ................... REPAIR/ADDITION(Prev. Son itation;Permit# ............................................ Date-- ----:------ .....�_-•] Septic Tank (Specify Requirements) ------------------------- -------••--- ------- •- -------............. . ......---. ------------ Disposal Field (specify Requirements) ........12----------------- -------------------------------------------------------- --------------------------------------•_....._._.... --------------------• ------- ------------ ............................................. Prow existing and required addition on reverse side) I r -- -•�,. ", 1 I hereby certify that I have prepared this application and that the work will''#se 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 f6r which this p irmit is issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ----------------•--•--- s Owner B ....... - Title GL1l_.�----- --- Y .�_.. ---------- -------------------------------- (I ..._._ (If other t owner) FOR DEPARTMENT SE ONLY APPLICATION ACCEPTED BY -_ - ------ .1 . .......... ... • - -- --------- DATE BUILDING PERMIT ISSUED -------•.................................. -DATE _..._....._ ......... ADDITIONAL COMMENTS ------------------- -------•--•- - .......------------...................................-----------..........»..__---.___._-_.______---_____--_._-__________ ._ .. ! _ Final Inspection b - ��pate -- - _---- "4r�.__ ...__...-•------- P Y -•------------ -----------•----------••- • ----•----....----•- -•-----•-----•- --- ------•- ..... ]EH 13 24 1-68 Rev. 5H SAN JOAQUIN LOCAL HEALT STRICT 8/74 3M