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to` FOR OFFICE USE: APPLICATION lFOlt SANITATION PEF,'T ---------------- •� (Complete in Triplicate) ANN __ _ -__----_ --_--_--_- This Permit Expires 1 Year From Date Issued Date Issued .__.--/9-7-3- Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: 1_�/ = 6 3� _. JOB ADDRESS/LOCATION .----'------------- y- -� -- � _ !1%_-CENSUS TRACT --•.-----�--- Owner's Name ------ --------------------------•- --------------------------------------- Phone _-----------------. ....... Address ----- ----R&___Id° ------ S '3----------• -------------------------------- City -49, ----------------------------------------- ------•-- Contractor's Name ---- ,a''"e----------------------------------------- -----------------------License # ---------:-------------- Phone .-.---------------------_---- Installation will serve: Residence jr Apartment House❑ Commercial:❑Trailer Court ❑ Motel ❑Other -----------------------------------•-•------ Number of living units:--- _1\__ 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 Q Clay .❑ Peat❑ Sandy Loam ❑ Clay Loam, Hardpan Adobe`Q 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,) W PACKAGE TREATMENT E SEPTIC TANK Size____ _ _ ___ __ __ _________________ Liquid Depth __47----------_Capacity A---------- Type _ - ar?�'__ Material--jArP4�-------- No.. Compartments -2;�'"'....:.......... O �� Prop. Line ..`5��....: Distance to nearest: Well -____�____Q_____________________Foundation ____________.. .___ .. _....... LEACHING LINE J1 No. of Lines ----A---------------- Length of each line------/_1M------------ Total Len th __.�-�_---__.-__•_ 'D' Box _ ype Filter Material -P �:-____Depth Filter Material __a ............................... Distance to nearest: Well :__3________ _______ Foundation _____________________ Property Line ................ �o /D A SEEPAGE PIT Depth __.�S�______ Diameter -_ _..__. Number _.____-- ____ Rock Filled YesJ No Water Table Depth ----4Sd--------------•----- - - --•----Rock Size -- yt_ Foundation ./-b-�__._---.. Prop.Distance to nearest. Well._3�2_________________________ _ _ p. Line .......... REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ________-•-••-._-_______________._) k SepticTank (Specify Requirements) ---------------------------------------------------------------------- ........-------------------------------...__......._....------ ---••- Disposal Field (Specify Requirements) ----------------------------------------•------------------------------------------------------------------- --------•-----------•-•- ----------------------------------------------•----------------------------------------------•-----•-•--------------•----------------- ----•-----------------------------------w---------•-------------- ----•------------------------------------------ ----------•---- ---------------------------------------------------- (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 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 t Wo kma s ompeennsat' laws of California." Signed ---------- Owner ' By ------------------------------------------------------------------------------------ ------------------ Title ---------------------- --------------------------------------------:---- ' (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - -----------------------------------------------------------= DATE -7-' 'f` `3-----------•- BUILDING PERMIT ISSUED ----------------------------------•---•------- -------DATE ----------------------••------------------- ADDITIONALCOMMENTS -------------------------------------------------------------------------------------------------------------------------------------------------- --•-------- ------------------------ ------------------------------------------------------------------------------------ ----- -------- -------------------------------- = - �g Final Inspection by. - - -- ----------- - Date _d r ----- ---------------- ` SAN JOAQUIN LOCAL HEALTH DISTRICT �,Cy E. H_ 9 1-'68 Rev_ 5M J�