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4 ----- f FOR OFFICE USE: PPLICATION • FOR SANITATION PEnT ------------ -------•------------------------- (Coni'plete in Triplicate) Permit No: ____ .-? F " Date Issued -------•••------ - ____________ �]� This Permit Expires ] 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 No. 549 and existing Rules and Regulations: JOB ADDRESS/LOC r.�- --------:---f -4 Sy �j __ ._ _-CENSUS TRACT ._.____-. Owner's Name ------ -�C-- - ,.. Phone°.. r - - - --- -------- Address _-"_ E-_! -•- -------- -- --- ----- Ci '`— r Contractor's Name ------- ---- ---- ''Z�d'z J ` . ---License # _!_ cP3 Phone ................... Installatign will serve: Residence PApartment House C] Commercial:❑Trailer Court ❑ Motel 0 Other ------ ----•------------------------- -- I - . Number of living units:_---...... 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❑ Clay .❑ Peat❑ Sandy Loam ❑ Clay Loam' Hardpan ❑ Adobe ❑ 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 TANK '`4' Sizer-l--„�--I t ' P Liquid Deprh --- ----- -•---•-.•--- \ ' Capacity _ C - 9- ` G Type ;��s,£ Materi d' - : No. Compartments .__.v} Distance to nears : Well -------- 1ri_-_.......... ---Foundation ------ - ---- Prop. Line`S.___---___-•- 4 LEACHING LINT: "` No. of Lines ________-__ __ Length of each line___._____`�'"_.._______ Tota! Length �_� .. .I o r� 'D' Box -___ _______ Type Filter Material ------:.3-_Z..Depth Filter Material ------------ _.____. . Distance to nearest: Well -----=--- ------""_"-- Foundation ----- ---------- Property Line .__ } SEEPAGE PIT Depth �� r •' ---------------- p --- ----------- Diameter .33._..-- Number ------- ----------- Rock Filled Yes (�'` No 1 — Water Table Depth � Rock Size -------------- /-- -•----- ----- --------- .jC. _ r Foundation Distance to nearest: Well .------------- --___--_"" (` --!�-"-. Prop. Line ....... REPAIR/ADDITION(Prev. Sanitation Permit# ---------------------- ---------- Date -------------------_ Septic Tank (Specify Requirements) __________________ _ _ Disposal Field (Specify Requirements) ............1------------------------------------------ --------------------------------------------- ------- -------------- - -- --- - ------- -- ----- ---- --- -- - _ (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, 1 shall not employ any person in such manner as to become subject to Wor a Compensa o laws of California," Signed ------------------------------ -- wne ------------- --- - O r By ------------------------------r t wnerl �° ,FOR .DEPA TMENT USE ONLY APPLICATION ACCEPTED BY BUILDING PERMIT ISSUED _-- �. :--7�� .._".---•------- -•---- -------------- -- DATE -_- ----------------""""-- - - -- -- DATE _ ADDITIONAL COMMENTS --------------------------------------------- ------ --- ---------------•----------------- - - --------------------- I ... ------------------------- ------------ ---------------- -••---------------------------------------------------------------------------------------•--------------••----------•-------•------------- ----------------------------• - ----------------------------------- Final Inspection by: -_""-- - =•----- --- Date -•�---------•------- SAN JOAQUIN LOCAL HEALTH DISTRICT flab E. H. 9 1-'68 Rev. 5M V