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y ! �FQR FFICE-USE: k . (kPPLICATION FOP. SANITATION P�11T . Permit No. _. __.��I .... ; ✓ l�� {Complete in Triplicate) -------- ------------- 214`711 _______________________ ___-_ _ This Permit Expires ] Year From Date Issued 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/LOCATION�.- �.?. ,+C` L - '— - ---------------------------------CENSUS TRACT ----------- F Owner's Name ' ---- -- - _ 1,SSC?_ tv------------ ---- ----------------------- ---------- Phone __.41to- Address .--------•--------------- -•It V_- -- - 3-77Z7n;---••--•! -- ------- - ---- ----------. City __. oe ................. Contractor's Name .----------'�-- --- _SB'? _ -- ---------License # -UD Sl. ------ Phone ,7 Installation will serve: I Residence partment House❑ Commercial ❑Trailer Court :E3E� Mo el ❑Other-------------------- ..................... 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 ❑ j; II Hardpan ❑ Adobe Fill Material ------------ If yes,type ____________________________ N J !! — -- (Plot plan, showing size o'If 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,] J !� I . ----------- _tt...:_:. .--------- --- `-------------- Liquid Depth __-------------------- PACKAGE ----------••-----PACKAGE TREATMENT SEPTIC TANK Size__.___._ Cdpacify y = Type =I Menal---------------------- No. Compartments ---------------------- 1 _----------------•-- 1 Foundation ______________________ Prop. Line -_____________--__-•_Distance 'to nearest: Well _____.____ LEACHING N i EINE [ j No: of Lines -------::......::.____ Length of each line_.....__..___.__.___.----__ Total Length .......................... 'D' Box ------------ Type Filter Material --------------------Depth Filter Material ........................................ -_-- Distance to nearest: Welf ----------------------- Foundation _:.......=::---------___ Property Line ........................ �o Sil EEPAGE PIT [ ] Depth -------------- Diameter _______ _______ Numbe --------------------------- Rock Filled Yes ❑ No C] I !1 Water Table Depth ------------------------------------------------Rock Size --------------------------- i Distance.to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line .----_-..---._.--_.--- REPAIR/ADDITION(Prev. Sanitation Permit# ___ _ .________ .................. I�Septic Tank (Specify Requirements) ____________ __ _____ ___ �ate •-•n.� /-f1 1 orf `)Disposal Field (Specify -Requirements) equirements) --._� _--- -Q %-- --- � - ---- ----------- =-------------------------------- •-----., ---------------- - -- -----------------------._...------:------•----•----------:--------•---------- (Draw existing�artat-required-addition on reverse-side) I hereby certify that I have prepared this policatilon and that the work will be done in accordance with San Joaquin County Ordinances, State LWws'arid 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 alto become subject to Workman's Compensation laws of California." Signed _..-----•--(--I--- --------------'�- ----• -- - --- - -- Owner BY` -- r --------------------------------------------------------------- title----- ---- -- - o- e -n - -------- ---- fthr th n ow FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----------------------- ---_.................•. •----------••-•-- DATE _ _�P._.� BUILDING PERMIT ISSUED !l - -------DATE ------------------------------------------- I ADDITIONALCOMMENTS _0------------------------------------------------------------------------------------------------- ;� --------- f---------------------------- ----------•--•-- ......... ---- ------ ---- ----•--------- -------- ----- ----- --- -------- - Firial inspection ') ins ection by: ----- ------ -•-------- --------------------mate ------------"---------b-------- --- --/---j-- --- I -_:. r SAN JOA LOCAL HEALTH DISTRICT 6 E. H. 9 1-'68 Rev. 5M .