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�l rr FOR OFFICE USE: APPLICATI 5N-FOR SANITATION PERMIT Permit No. ..__w=-� _----- ---" _----- --------- (Complete in Triplicate) --•.--._.-----•_----- Date Issued �---�'--�-6 - ---- 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 herei described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: _.. 4 JOB ADDRESS/LOCAT N ._ ---..r___CENSUS TRACT 7 17o -_ v lt C one Owner's Nome ------------- Address ----- --------------74. City -------- Contractor's Name --_- f Q --------License # � Sid Phone installation will serve: Residence ❑ Apartment House❑ Commercial ❑Trailer Court Motel Q Other Number of living units-------------- Number of bedrooms _-_.-___-Garbage Grinder f___. ..__ Lot Size -. -- ----- - �!��(/ - -a_' Private ❑ Water Supply: Public System and name _____________________ ----------- - --- - Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam Q 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,) ;. -- --- Liquid Depth ---------------------.----- PACKAGE TREATMENT [ ] SEPTIC TANK:[ ] Sixe_..___._.________________________ ___ q P �. i Capacity No. Compartments ------------------- P Y - ------------- - Type - ---- ---- --- Material.. .- ., Distance to nearest: Well ------------------------------------Foundation --- "----------- Prop. Line ----- ------- c ------------------- Length of each line---------------------------- Total Length ------ -------------------- LEACHING LINE [ J No. of Lines 9 'D' Box . ----- Type Filter Material --------- ----------Depth Filter Material .... --_.___-..-_----•----------••----- Distance to nearest: Well -_-_--_________________ Foundation _ Property Line ._____-..___._____-- ---------------- SEEPAGE PIT Depth Diameter Number _-_----.-- _-- Rock Filled Yes C] No ---- ---------- Water Table Depth .................. -------------Rock Size -------"------------ -"----- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line .___-----__-_-__--..:- 4 REPAIR/ADDITION(Prev. Sanitation Permit# ------------------------ ---------- ------ Date .------------------------- ----------------------- Septic Tank (Specify Requirements) ------------------- - - - -----------•-- --------------- _--------- ---- le Disposal Field (Specify Requirements) .....- - ----- ---------------- ------ � ------ - ----r-- -- ---------- -- -------•------ -- --- - -- --- --- - (Draw existing Ifind required addition on reverse s; 1 hereby certify that I have prepared this application and that the work will be done in accordance with Son 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 •--- Title . --- ----------•--------- ------ (I othe an owner) FOR DEPARTMENT USE ONLY h a APPLICATION ACCEPTED BY -. ____----- ----- ------------ -----. DATE ----- ----- -----..............----- - BUILDING PERMIT ISSUED ----• - ---- ---------------- ------------------ DATE _._ ADDITIONAL COMMENTS ------------------- a �s. ,_--�--------- - -- a .. - _ -- --------------------------------- -------------- � �- -------- -- -- --- - ----------------a ° -� - ---.Date Final Ins ection b -- - - -- - SAN JOAQUIN .LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M