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FOR OFFICE USE: V-4- °LIGATION FOF� SANITATION PERM � . . _ . - s_V8" ---- ---- - �".i (Complete in Triplicate) � Permit No. _Z3- -..... _. ._......... . . ---- -...._ _ 6 1C-7� .---__-------__-.....-- __ This Permit Expires I Year From Date Issued Date Issued ................... r 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. S49 and existing Rules and Regulations: JOB ADDRESS/LOCATIONf /(/i-- -=_------ ....._._....._CENSUS TRACT -------------.------ Owner's Name ----- - --------------------------------------- -•--- --------------------------------Phone..y7 :7� ....... Address ------.--5AM, _ .. Cit Contractor's Namer/ _---------------_License # /7r�..9.V-DI.... Phone . - _�.. Installation will serve: Residence T Apartment House❑ Commercial ❑Trailer Court ❑ Motel ❑Other .____ .-.... ... ----------___ .___ Number of living units: ---I..._ Number of bedrooms .,-----Garbage Grinder -__. Lot Size 1i_/'tie4�.5..._-_ ........ _ Water Supply: Public System and name ---------------------------------------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat p Sandy Loom 0 Clay Loam�( i 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,) r. PACKAGE TREATMENTSize. SEPTIC TANK . .- [ � '� �+ XS7?�'- -- Liquid Depth yV------------ - 111q Capacity�d��1X¢�/._ Type _. _ 1G `7-Material rNo. Compartments I^) a Distance to nearest: WeII -�L_�_......__..___-__.-Foundation .14F---_ --------_ Prop. Line s------__._._ LEACHING LINE M No. of Lines -__.�_-___._.__. Length of each line_1UQ ------- Total Length YeK4_l-------_.._-_ 'D' Box NO--._ Type Filter Material Rrl�( � ----Depth Filter Material ./2C----------------------------------- Distancetonearest: Well � Foundation ------- Property Line �—-_.-...__._._ SEEPAGE PIT [ Depth .p,,j.._.._._. Diameter 3G_ ._.. Number _../------_. ---.-------- Rock Filled Yes No ❑ Water Table Depth -----7.L'I-)-._i------------ .�,-----.--Rock Size �/0-i.--i--------- like ------/� Distance to nearest: Welly_. ---I �' _ . -____._ t_-._._._.Foundation .��-......___ Prop. Line REPAIR/ADDITION(Prev. Sanitation Permit# -------------------___ -------- --- .._- Date ------------------------ .___._) ` Septic Tank (Specify Requirements) _... Disposal Field (Specify Requirements) ._------------------------. ----------- ------------------ -------- _ ------------------_.._. .....---------..-_._.- ...............--------------............ - --- - - -- -------------------- (Draw existing and required addition on reverse side) I hereby certify that 1 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 Workman's Compensation laws of California." SignedOwner - -.. - ... ---- By - - ---- - ------ - ---�.:-C��/� .. -_ ---- -- Title -- ` (IfI ther41 owner) F01 DEPARTMENT US ONLY APPLICATION ACCEPTED BY ._ _`� ---- -- ------------------------------.. DATE ---- %..... .- - - .. BUILDING PERMIT ISSUED ---- -------- --- ------------- ----- ----- -------- -__DATE ADDITIONAL COMMENTS -------------------- - -------- ------- - ---------- ----- - -................ .. -- -' - ------------- - --- - - ------- - -- - -_---------------- ..... .. -------- - --- - - - Final Inspection by: ---- -- - - ------ ---- - - ---------Date ------ - ---l.' � SAN JOAQU LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M